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.