Periacetabular Osteotomy Is Associated with Significant Improvement in Patient-Reported Sexual Function:A Study Based on the UK Non-Arthroplasty Hip Registry (NAHR)

Background<br/>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. <br/><br/>Purpose<br/>This study used data from the UK Non-arthroplasty Hip Registry (NAHR) to describe the impact of PAO on patient reported sexual function (SF). <br/>Study design: Retrospective cohort study of prospectively collected data<br/><br/>Methods<br/>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’).<br/><br/>Results<br/>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.<br/>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&lt;0.0001), with continued improvement to +26.4 points (95%CI 23.0 - 29.8) at 12 months (p&lt;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.<br/><br/>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<br/><br/>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.<br/><br/>Conclusion<br/>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.<br/><br/>Clinical relevance<br/>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.