# Sexual function and pregnancy outcomes after periacetabular osteotomy: a systematic review

## TL;DR

This review examines how periacetabular osteotomy affects sexual function and pregnancy outcomes, finding some improvement in sexual function and higher cesarean section rates.

## Contribution

The study provides new insights into the effects of PAO on sexual function and pregnancy outcomes, highlighting gaps in current evidence.

## Key findings

- 48.2% of patients reported improved sexual function after PAO.
- Female patients showed greater improvement in sexual function compared to males.
- Patients post-PAO had a higher cesarean section rate (37.4%) compared to the European average.

## Abstract

Periacetabular osteotomy (PAO) is a surgical treatment of developmental dysplasia of the hip (DDH). This systematic review investigates the impact PAO has on sexual function and pregnancy through changes in patient-reported outcomes. A literature search of Medline, PubMed, EMBASE, and the Cochrane Library from 1996 to November 2023 was performed. Search terms included: ‘periacetabular osteotomy’, ‘pelvic osteotomy’, ‘outcomes’, ‘sexual function’, ‘pregnancy’, and ‘childbirth’. Assessment of methodological quality was performed using the methodological index for nonrandomized studies (MINORS) criteria and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. The search returned 560 papers, with 5 meeting the inclusion criteria. Sexual function improved over both short- and longer-term follow-up periods. 48.2% of patients had improved sexual function following PAO. Female patients reported greater improvement than males, who had a higher baseline score. No complications were documented in pregnancy or delivery compared to patients who had not had a PAO. Increased rates of caesarean sections (CSs) were seen in all studies (37.4%) compared to the European average. All five papers were calculated to be of low quality according to the MINORS criteria and low certainty according to the GRADE level of evidence. Patients receiving a PAO due to symptomatic DDH had improved sexual dysfunction due to a reduction in hip pain, but almost half of these patients may not appreciate any benefit. There is an increased likelihood of CS in patients post-PAO, with no reliable evidence for its necessity. Limitations of this review included poor quality and availability of evidence, as all studies were retrospective cohort studies. Further larger powered studies are required to assess the full impact of PAO on both sexual function and pregnancy.