EP1.66 The Treatment of Acetabular Retroversion: Hip Arthroscopy or Periacetabular Osteotomy? A systematic review on diagnostic criteria and outcomes

Abstract

Abstract Background Acetabular retroversion (ARV) causes femoroacetabular impingement (FAI). ARV is managed by anteverting periacetabular osteotomy (PAO) or hip arthroscopy (HA), though their comparative effectiveness is unknown. Methods A PRISMA-compliant systematic review was conducted using PubMed, CINAHL, EMBASE, and Cochrane Library. Data included ARV diagnostic criteria, patient-/physician-reported outcome measures (PROMs), concurrent procedures, complications, and further surgeries. Study quality was assessed using MINORS and Coleman Methodology Score (CMS). Results Among 12 HA studies (1,060 patients), 78% (822/1,060) underwent surgery for indications other than ARV; 60.3% (639/1,060) had all 3 radiographic ARV signs, with 83.8% undergoing rim-trimming. Modified Harris Hip Score (mHHS) was the most common PROM; 68.9% achieved a patient-acceptable symptom state (PASS). Complication rates were 1.9%, with 1.2% converting to total hip arthroplasty (THA) and 5.3% undergoing revision HA at 5 years. Among 7 PAO studies (312 patients), all surgeries targeted ARV exclusively; 74.4% (232/312) demonstrated all radiographic signs. Merle d’Aubigne-Postel (MdAP) hip score was the most frequent PROM with 89.4% achieving good-excellent scores. Complication rates were 13% (27/201), with 0.6% converting to THA at 10 years. Four PAO studies (4/7) and six HA studies (6/12) met high-quality MINORS criteria. No studies directly compared HA to PAO. Conclusion There is marked variation in the definition of ARV and its surgical management in the current literature. While HA provides good mid-term symptomatic relief, the patients were less likely to have all three signs of acetabular retroversion, compared to PAO patients. Therefore, current evidence on the surgical management of ARV should be interpreted with caution.