Abstract
Background
Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI - principally acetabular retroversion) in adults who are commonly of reproductive age.
Purpose
This study used data from the UK Non-arthroplasty Hip Registry (NAHR) to describe the impact of PAO on patient reported sexual function (SF).
Study design: Retrospective cohort study of prospectively collected data
Methods
Adult patients who underwent isolated PAO between January 2012 and July 2022 were extracted from the NAHR. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months postoperatively. This included responses to two questions from the iHOT-12 questionnaire relevant to SF: (1) “are questions about SF relevant to you?” and (2) “how much trouble do you have with sexual activity because of your hip” (0=‘severe’, 100=‘none’).
Results
773 patients (median age 29 years (IQR 23 - 37), 92.5% female) who underwent PAO for DDH (n = 703, 90.9%) or FAI (n = 70, 9.1%) were identified after exclusions. 88.2% of iHOT-12 respondents indicated that SF was relevant to them.
Baseline median iHOT-12 SF scores were 33 (IQR 18, 53) for female and 73 (IQR 36, 90) for male patients. Female iHOT-12 SF improved by a mean of +19.9 points (95%CI 16.5 - 23.2) at 6 months (p<0.0001), with continued improvement to +26.4 points (95%CI 23.0 - 29.8) at 12 months (p<0.0001) vs preoperative SF scores. At 12 months, median iHOT-12 SF scores were 70 (IQR 40, 90) and 89 (70, 99) for female and male patients respectively.
Preoperative SF scores were significantly lower (p=0.0011) in patients who underwent PAO for indication of FAI (female median score 22, IQR 10 - 38) compared to DDH (female median score 34, IQR 18 - 54), however, both indications saw significant improvement in SF scores at 12 months. iHOT-12 SF scores improved for 77.1% and worsened for 19.1% of female respondents with DDH
A strong positive association was seen between health-related quality of life (EQ-5D) and SF scores, and there was significant improvement in SF across studied ages.
Conclusion
PAO was associated with significant improvement in patient reported sexual function for the majority of patients. Some patients may have trouble with sexual activity even 1 year following PAO for DDH, with 19% reporting poorer sexual function compared to pre-operative baseline.
Clinical relevance
Findings of our study are relevant to healthcare professionals treating such patients, the majority of whom are of reproductive age, and can expect significant improvement in sexual function following PAO.
Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI - principally acetabular retroversion) in adults who are commonly of reproductive age.
Purpose
This study used data from the UK Non-arthroplasty Hip Registry (NAHR) to describe the impact of PAO on patient reported sexual function (SF).
Study design: Retrospective cohort study of prospectively collected data
Methods
Adult patients who underwent isolated PAO between January 2012 and July 2022 were extracted from the NAHR. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months postoperatively. This included responses to two questions from the iHOT-12 questionnaire relevant to SF: (1) “are questions about SF relevant to you?” and (2) “how much trouble do you have with sexual activity because of your hip” (0=‘severe’, 100=‘none’).
Results
773 patients (median age 29 years (IQR 23 - 37), 92.5% female) who underwent PAO for DDH (n = 703, 90.9%) or FAI (n = 70, 9.1%) were identified after exclusions. 88.2% of iHOT-12 respondents indicated that SF was relevant to them.
Baseline median iHOT-12 SF scores were 33 (IQR 18, 53) for female and 73 (IQR 36, 90) for male patients. Female iHOT-12 SF improved by a mean of +19.9 points (95%CI 16.5 - 23.2) at 6 months (p<0.0001), with continued improvement to +26.4 points (95%CI 23.0 - 29.8) at 12 months (p<0.0001) vs preoperative SF scores. At 12 months, median iHOT-12 SF scores were 70 (IQR 40, 90) and 89 (70, 99) for female and male patients respectively.
Preoperative SF scores were significantly lower (p=0.0011) in patients who underwent PAO for indication of FAI (female median score 22, IQR 10 - 38) compared to DDH (female median score 34, IQR 18 - 54), however, both indications saw significant improvement in SF scores at 12 months. iHOT-12 SF scores improved for 77.1% and worsened for 19.1% of female respondents with DDH
A strong positive association was seen between health-related quality of life (EQ-5D) and SF scores, and there was significant improvement in SF across studied ages.
Conclusion
PAO was associated with significant improvement in patient reported sexual function for the majority of patients. Some patients may have trouble with sexual activity even 1 year following PAO for DDH, with 19% reporting poorer sexual function compared to pre-operative baseline.
Clinical relevance
Findings of our study are relevant to healthcare professionals treating such patients, the majority of whom are of reproductive age, and can expect significant improvement in sexual function following PAO.
| Original language | English |
|---|---|
| Journal | Orthopaedic Journal of Sports Medicine |
| Publication status | Accepted/In press - 17 Feb 2025 |