Physical impairments in adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis

Michael O'Brien, Julie Sandell Jacobsen, Adam Ivan Semciw, Inger Mechlenburg, Lisa C. U. Reimer, Christopher Stewart, Joshua Heerey, Joanne Kemp

Publikation: Bidrag til tidsskriftTidsskriftsartikelForskningpeer review


Background: Developmental dysplasia of the hip (DDH) is a leading cause of hip pain and impairments. Periacetabular osteotomy (PAO) is the most common surgical treatment for DDH. Outcomes following PAO have historically been based on radiology or patient reported outcomes, and not physical impairments.

Objective: To investigate differences in physical impairments in adults with DDH undergoing PAO compared with asymptomatic participants, and to investigate pre- to post-PAO changes in physical impairments.

Design: Systematic review with meta-analysis
Data Sources: A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO), using the PRISMA checklist.
Study Selection: Studies were considered if patients were above 15 years, treated with PAO for DDH and if they included a physical impairment outcome measure.
Data Extraction and Synthesis: Two independent reviewers performed data extraction and assessed methodological quality, using a modified version of the Downs and Black checklist.

Results: Of 5,017 studies, 24 studies were included with 2190 patients. The methodological quality scores ranged from 39% to 88%. With low level of evidence, meta-analysis showed 58% of patients had a positive anterior impingement test (95%CI: 39-76%), prior to PAO and 1-3 years later. Five years after PAO, the proportion fell to 17% (95%CI: 11-24%). Prior to PAO, patients with DDH walked with a lower peak hip extension angle, compared to asymptomatic participants (SMD 0.65 (95%CI 0.21-1.10).
Best evidence synthesis of non-pooled data showed limited evidence of increased walking velocity, stride length and improved hip flexion and extension moment 18-months post-PAO compared to pre-op. Cadence, hip abduction and hip flexion strength did not change.

Conclusion: Most patients with DDH have a positive hip impingement test, pre-PAO. Compared to asymptomatic participants, patients with DDH demonstrate physical impairments during walking which appear to improve after surgery. Hip abduction and flexion strength did not change pre- to post-PAO.

TidsskriftInternational Journal of Sports Physical Therapy
Udgave nummer6
Sider (fra-til)988-1001
Antal sider14
StatusUdgivet - jun. 2022


  • Sygdom, sundhedsvidenskab og sygepleje
  • Hip dysplasia
  • Hip pain
  • Joint disase
  • impairment


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