Periacetabular osteotomy with intraoperative computer-assisted modalities: a systematic review

The role of intraoperative computer-assisted modalities for periacetabular osteotomy (PAO), as well as the perioperative and post-operative outcomes for these techniques, remains poorly defined. The purpose of this systematic review was to evaluate the techniques and outcomes of intraoperative computer-assisted modalities for PAO. 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 (<10 patients), non-English language and studies that did not provide a description of the computer-assisted technique. Data extraction included computer-assisted modalities utilized, surgical techniques, demographics, radiographic findings, perioperative outcomes, patient-reported outcomes (PROs), complications and subsequent surgeries. Nine studies met the inclusion criteria, consisting of 208 patients with average ages ranging from 26 to 38 years. Intraoperative navigation was utilized in seven studies, patient-specific guides in one study and both modalities in one study. Three studies reported significantly less intraoperative radiation exposure (P < 0.01) in computer-assisted versus conventional PAOs. Similar surgical times and estimated blood loss (P > 0.05) were commonly observed between the computer-assisted and conventional groups. The average post-operative lateral center edge angles 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 post-operative values of patients undergoing computer-assisted PAOs. 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. Compared to conventional techniques, decreased intraoperative radiation exposure and similar operative lengths were observed with computer-assisted PAOs, although these results should be interpreted with caution due to heterogeneous operative techniques and surgical settings.