Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in patients with PAO.
Basic procedures
In the period 1999-2008, 93 patients (127 hips, median patient age 31, range 13-49 years) were operated on with PAO. Median follow-up was 7 (SD 2.1) years. Analyses of clinical and radiographic examinations, including WOMAC, were performed. Osteoarthritis was measured using Tönnis grade. Survival was assessed by the Kaplan-Meier method and predictors of conversion to THA were calculated using Cox regression analysis with THA as defined endpoint.
Main findings
Centre-edge angle improved significantly with a mean of 8.7 (95% CI: 7.1; 10.3) preoperatively to a mean of 24.6 (95% CI: 22.6; 26.6) at follow-up. Likewise the acetabular roof obliquity angle improved significantly with a mean of 21.2 (95% CI: 19.7; 22.6) preoperatively to 8.7 (95% CI: 7.1; 10.4) at follow-up. Eleven out of 127 hips had conversion to THA. The 11.7 years cumulated hip joint survival rate was 85% (95% CI: 0.753; 0.945). Significant predictors of converting to THA were preoperative high grade of OA and postoperative high degree of acetabular roof obliquity angle. An improvement was found in Harris Hip Score pain score after receiving a PAO (p = 0.01).
Conclusions
Our results, with almost 12 years survival data, are comparable with the literature. PAO is considered as an effective treatment for young adults with painful hip dysplasia, especially when preoperative criteria for conversion to THA are highlighted.
Get full access to this article
View all access options for this article.
References
1.
GanzRKlaueKVinhTSMastJWA new periacetabular osteotomy for the treatment of hip dysplasias.Technique and preliminary results.Clin Orthop Relat Res1988;232:26–36
2.
SteppacherSDTannastMGanzRSiebenrockKAMean 20-year followup of Bernese periacetabular osteotomy.Clin Orthop Relat Res2008;466:(7)1633–44
3.
MatheneyTKimYJZurakowskiDMateroCMillisMIntermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome.J Bone Joint Surg Am2009;91:(9):2113–23
4.
ItoHTaninoHYamanakaYMinamiAMatsunoTIntermediate to long-term results of periacetabular osteotomy in patients younger and older than forty years of age.J Bone Joint Surg Am2011;93:(14)1347–54
5.
GarrasDNCrowderTTOlsonSAMedium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip.J Bone Joint Surg Br2007;89:(6)721–4
6.
ClohisyJCNunleyRMCurryMCSchoeneckerPLPeriacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities.J Bone Joint Surg Am2007;89:(7)1417–23
7.
TroelsenASøballeK[Periacetabular osteotomy and hip dysplasia in young adults]. [Article in Danish].Ugeskr Laeger2009;171:(14)1185–9
8.
JacobsenSSonne-HolmSHip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey.Rheumatology (Oxford)2005;44:(2):211–8
9.
SiebenrockKALeunigMGanzRPeriacetabular osteotomy: the Bernese experience.Instr Course Lect2001;50239–45
10.
TroelsenAElmengaardBSøballeKA new minimally invasive transsartorial approach for periacetabular osteotomy.J Bone Joint Surg Am2008;90:(3)493–8
11.
TroelsenAElmengaardBSoballeKMedium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement.J Bone Joint Surg Am2009;91:(9):2169–79
12.
KraljMMavcicBAntolicVIglicAKralj-IglicVThe Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7-15-year follow-up of 26 hips.Acta Orthop2005;76:(6)833–40
13.
PolkowskiGGNovaisENKimYJMillisMBSchoeneckerPLClohisyJCDoes previous reconstructive surgery influence functional improvement and deformity correction after periacetabular osteotomy?Clin Orthop Relat Res2012;470:(2)516–24
14.
MurphySBGanzRMullerMEThe prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome.J Bone Joint Surg Am1995;77:(7)985–9
15.
TrousdaleRTEkkernkampAGanzRWallrichsSLPeriacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips.J Bone Joint Surg Am1995;77:(1)73–85
TroelsenASurgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults.Acta Orthop Suppl2009;80:(332)1–33
20.
PogliacomiFStarkAWallenstenRPeriacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years.Acta Orthop2005;76:(1)67–74
21.
McKinleyTOThe Bernese periacetabular osteotomy for treatment of adult hip dysplasia.Skeletal Radiol2010;39:(11)1057–9
22.
BurkeNGDevittBMBakerJFOutcome of periacetabular osteotomy for the management of acetabular dysplasia: experience in an academic centre.Acta Orthop Belg2011;77:(1)33–40
23.
TroelsenAAssessment of adult hip dysplasia and the outcome of surgical treatment.Dan Med J2012;59:(6)B4450
24.
NunleyRMPratherHHuntDSchoeneckerPLClohisyJCClinical presentation of symptomatic acetabular dysplasia in skeletally mature patients.J Bone Joint Surg Am2011;93Suppl 217–21
25.
BiedermannRDonnanLGabrielAWachterRKrismerMBehenskyHComplications and patient satisfaction after periacetabular pelvic osteotomy.Int Orthop2008;32:(5)611–7
26.
MillisMBKainMSierraRTrousdaleRTauntonMJKimYJPeriacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study.Clin Orthop Relat Res2009;467:(9):2228–34
27.
BellamyNThe WOMAC Knee and Hip Osteoarthritis Indices: development, validation, globalization and influence on the development of the AUSCAN Hand Osteoarthritis Indices.Clin Exp Rheumatol2005;235 Suppl 39S148–53
28.
BellamyNBuchananWWGoldsmithCHCampbellJStittLWValidation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.J Rheumatol1988;15:(12)1833–40
29.
SørensenJDavidsenMGudexCPedersenKMBrønnum-HansenHDanish EQ-5D population norms.Scand J Public Health2009 Jul37:(5)467–74
30.
HarrisWHTraumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.J Bone Joint Surg Am1969;51:(4)737–55
31.
PetersCLEricksonJAHinesJLEarly results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center.J Bone Joint Surg Am2006;88:(9)1920–6
32.
ThawraniDSucatoDJPodeszwaDADeLaRochaAComplications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents.J Bone Joint Surg Am2010;92:(8)1707–14
33.
TroelsenAElmengaardBSoballeKComparison of the minimally invasive and ilioinguinal approaches for periacetabular osteotomy: 263 single-surgeon procedures in well-defined study groups.Acta Orthop2008;79:(6)777–84
34.
DaveyJPSantoreRFComplications of periacetabular osteotomy.Clin Orthop Relat Res1999;36333–7
35.
McKinleyTOThe Bernese Periacetabular Osteotomy: review of reported outcomes and the early experience at the University of Iowa.Iowa Orthop J2003;2323–8
36.
FujiiMNakashimaYYamamotoTMawatariTMotomuraGMatsushitaAAcetabular retroversion in developmental dysplasia of the hip.J Bone Joint Surg Am2010;92:(4)895–903
37.
XieJNaitoMMaeyamaAEvaluation of acetabular versions after a curved periacetabular osteotomy for dysplastic hips.Int Orthop2010;34:(4)473–7
38.
EzoeMNaitoMInoueTThe prevalence of acetabular retroversion among various disorders of the hip.J Bone Joint Surg Am2006;88:(2)372–9
39.
WernerCMCopelandCERuckstuhlTRadiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign.Acta Orthop Belg2010 Apr 76:(2)166–73
40.
ZiebarthKBalakumarJDomayerSKimYJMillisMBBernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?Clin Orthop Relat Res2011;469:(2)447–53
41.
HsiehPHHuangKCLeePCChangYHComparison of periacetabular osteotomy and total hip replacement in the same patient: a two- to ten-year follow-up study.J Bone Joint Surg Br2009;91:(7)883–8
42.
HussellJGRodriguezJAGanzRTechnical complications of the Bernese periacetabular osteotomy.Clin Orthop Relat Res1999;36381–92
43.
TroelsenAAssessment of adult hip dysplasia and the outcome of surgical treatment.[Doctorial Thesis]ÅrhusÅrhus University2011
