Summary

This systematic review evaluates intraoperative computer-assisted modalities for periacetabular osteotomy (PAO)

Abstract

Purpose

To evaluate intraoperative computer-assisted modalities for periacetabular osteotomy (PAO) to (1) provide a qualitative description of current applications for this technology, (2) analyze perioperative outcomes (e.g., surgical time, estimated blood loss (EBL), and radiation exposure), and (3) assess postoperative radiographic and patient-reported outcomes (PROs).

Methods

In June 2022, three databases (Pubmed, CINAHL/EBSCOHost, and Cochrane) were searched for clinical studies reporting on computer-assisted modalities for PAO. Exclusion criteria included small case series, non-English language, and studies that did not provide a description of the computer-assisted technique. Data extraction included computer-assisted modalities utilized, surgical technique, demographics, radiographic findings, perioperative outcomes, PROs, complications, and subsequent surgeries. The Methodological Index for Non-randomized Studies (MINORS) criteria was utilized for a qualitative study assessment.

Results

Nine studies met inclusion criteria, consisting of 342 patients with average ages ranging from 26 to 38 years. There was one level II, six level III, and two level IV studies. Intraoperative navigation was utilized in seven studies, patient-specific guides in one study, and both modalities in one study. Three studies reported significantly less radiation exposure (p<0.01) in computer-assisted versus conventional PAOs. Similar surgical times and EBL (p>0.05) were observed between the computer-assisted and conventional groups. Average postoperative (lateral center edge angles) LCEAs in patients undergoing computer-assisted PAOs ranged from 27.8° to 37.4°, with six studies reporting similar values (p>0.05) compared to conventional PAOs. Improved PROs were observed in all six studies that reported preoperative and postoperative values.

Conclusion

Computer-assisted modalities for PAO include navigated tracking of the free acetabular fragment and surgical instruments, as well as patient-specific cutting guides and rotating templates. While similar postoperative LCEAs are observed when compared to conventional techniques, decreased intraoperative radiation exposure and similar operative lengths are reported with computer-assisted PAOs.

Level of Evidence: IV, systematic review of Level II through Level IV studies

Keywords: Hip/thigh/pelvis; dysplasia; periacetabular osteotomy; computer-assisted; navigation; patient-specific