Trends in periacetabular osteotomy for dysplastic hip in South Korea: a ten year analysis of national health insurance data.

BACKGROUND

Hip dysplasia and secondary hip osteoarthritis are common in Asian populations, and are major causes of hip arthroplasty. Periacetabular osteotomy (PAO) is a joint-preserving surgical option for young patients with symptomatic hip dysplasia, aimed at preventing progression to end-stage arthritis. This study aimed to analyze the ten year trends in hip dysplasia diagnosis and PAO utilization in South Korea using national health insurance claims data.

MATERIALS AND

METHODS

This nationwide retrospective study analyzed data from the Health Insurance Review & Assessment Service (HIRA) covering 10-year period (2014-2023). The diagnostic trend of hip dysplasia was investigated alongside the trends in PAO surgeries. Population-based PAO rates were examined as the primary analysis, while PAO frequency relative to the cumulative number of diagnosed cases was additionally assessed as a secondary analysis, along with regional distributions and trends across age groups.

RESULTS

Over the ten year period, a total of 48,890 patients (63.7% female) were diagnosed with hip dysplasia, and 419 hips underwent PAO in patients aged ten years or older. The population-based PAO rate remained low throughout the study period, increasing from 0.049 per 100,000 population in 2014 to a peak of 0.115 in 2020, decreasing to 0.084 in 2021, and then stabilizing at approximately 0.088 in 2022-2023. In terms of hospital regional distribution, 155 out of 419 cases (37.0%) were performed in Seoul, followed by Jeonbuk Province with 148 cases (35.3%). By age group, the highest number of surgeries was performed in patients aged ten to 19 years (140/419 cases, 33.4%).

CONCLUSION

In South Korea, the population-based utilization of PAO remained low over the past decade despite a statistically significant increasing trend, and lagged behind the level reported in other countries. Whether this pattern reflects underuse of PAO, appropriate patient selection, or a shift toward alternative treatments cannot be determined from administrative claims data alone.