PDF herunterladen
The Journal of Hip Surgery 2017; 01(04): 167-172
DOI: 10.1055/s-0038-1635102
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Successful Outcomes at Midterm Follow-up of Periacetabular Osteotomy Done for Mild Hip Dysplasia

Rafael J. Sierra
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
G. David Potter
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Eduardo N. Novais
2   Child and Young Adult Hip Preservation, Boston Children's Hospital, Boston, Massachusetts
3   Assistant Professor, Harvard Medical School, Boston, Massachusetts
,
Robert T. Trousdale
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
› Institutsangaben
Weitere Informationen

Publikationsverlauf

30. August 2017

21. Dezember 2017

Publikationsdatum:
19. März 2018 (online)

   Lizenzen und Reprints

Abstract

Young hip surgeons are often faced with the decision to either perform arthroscopic surgery or a periacetabular osteotomy (PAO) in patients with symptomatic mild hip dysplasia (MHD). There is, however, a paucity of data on the results of PAO in this group. The aim of this paper is to report the results of PAOs in patients with MHD and compare those to hips with more severe forms of hip dysplasia (SHD). This data can then be used to compare emerging data reporting the results of hip arthroscopy for MHD. From January, 1996 to May, 2009, 299 hips in 268 patients were identified that underwent PAO at one institution. After removing those with <2 years of follow-up, 182 hips were followed up. The average age of the cohort was 31 years, and 85% were female. Nineteen hips with lateral center edge (LCE) angle from 18 to 25° and a Tönnis angle (TA) between 10 and 15° were considered to have MHD. This group was compared with the rest of the cohort (SHD). The mean clinical follow-up for the MHD group was 121 months. There was no significant difference in demographic variables between the groups. There were no complications in the MHD cohort. Surgical correction resulted in significant improvements in all radiographic measurements consistent with hip dysplasia in both groups. The Harris Hip Score (HHS) improved significantly in both groups ([MHD: 52–92] [SHD: 66–89]). Two hips (10.5%) in the MHD group and 15 hips (9.2%) in the SHD group underwent future THA (p = 0.69). The survivorship free from THA was 100%, 100%, and 86% at 3, 5, and 10 years, respectively, in the MHD group. The corresponding rates for hips in the control group at 3, 5, and 10 years, respectively, were 99%, 95%, and 81%. PAO in patients with MHD provides predictable improvements in pain, function, and results that are durable and comparable to hips with SHD. This data should be used to compare the early and midterm results of arthroscopic surgery performed in mildly dysplastic hips.

Keywords

hip dysplasia - periacetabular osteotomy - hip arthroscopy - young hip pathology
 

  • References

  • 1 Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 1986; (213) 20-33
    PubMedGoogle Scholar
  • 2 Murphy SB, Kijewski PK, Millis MB, Harless A. Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res 1990; (261) 214-223
    PubMedGoogle Scholar
  • 3 Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br 1976; 58 (02) 176-183
    PubMedGoogle Scholar
  • 4 Stulberg SD, Harris WH. Acetabular dysplasia and development of osteoarthritis of hip. In: Harris WH. , ed. The Hip. Proceedings of the Second Open Scientific Meeting of the Hip Society. St. Louis, MO: Mosby; 1974: 82-93
    Google Scholar
  • 5 Tönnis D, Legal H, Graft R. , eds. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin, Germany: Springer-Verlag; 1987
    Google Scholar
  • 6 Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995; 77 (07) 985-989
    CrossrefPubMedGoogle Scholar
  • 7 Lequesne M. ; de SEZE. False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies [In French]. Rev Rhum Mal Osteoartic 1961; 28: 643-652
    PubMedGoogle Scholar
  • 8 Tönnis D. Eine neue form der huftfannenschwenkkung durch dreifachosteostomie zur ermoglichung spoterer hufprothesenversorgung. Orthop Praxis 1979; 15: 1003-1005
    PubMedGoogle Scholar
  • 9 Wiberg G. Studies on dysplastic acetabulae and congenital subluxation of the hip joint. Acta Orthop Scand Suppl 1939; 58: 1-132
    PubMedGoogle Scholar
  • 10 Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med 2013; 41 (11) 2591-2598
    CrossrefPubMedGoogle Scholar
  • 11 Bogunovic L, Gottlieb M, Pashos G, Baca G, Clohisy JC. Why do hip arthroscopy procedures fail?. Clin Orthop Relat Res 2013; 471 (08) 2523-2529
    CrossrefPubMedGoogle Scholar
  • 12 Clohisy JC, Nepple JJ, Larson CM, Zaltz I, Millis M. ; Academic Network of Conservation Hip Outcome Research (ANCHOR) Members. Persistent structural disease is the most common cause of repeat hip preservation surgery. Clin Orthop Relat Res 2013; 471 (12) 3788-3794
    CrossrefPubMedGoogle Scholar
  • 13 Jackson TJ, Watson J, LaReau JM, Domb BG. Periacetabular osteotomy and arthroscopic labral repair after failed hip arthroscopy due to iatrogenic aggravation of hip dysplasia. Knee Surg Sports Traumatol Arthrosc 2014; 22 (04) 911-914
    CrossrefPubMedGoogle Scholar
  • 14 Matsuda DK, Khatod M. Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia. Arthroscopy 2012; 28 (11) 1738-1743
    CrossrefPubMedGoogle Scholar
  • 15 van Bergayk AB, Garbuz DS. Quality of life and sports-specific outcomes after Bernese periacetabular osteotomy. J Bone Joint Surg Br 2002; 84 (03) 339-343
    CrossrefPubMedGoogle Scholar
  • 16 Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am 2005; 87 (02) 254-259
    CrossrefPubMedGoogle Scholar
  • 17 Crockarell Jr J, Trousdale RT, Cabanela ME, Berry DJ. Early experience and results with the periacetabular osteotomy. The Mayo Clinic experience. Clin Orthop Relat Res 1999; (363) 45-53
    PubMedGoogle Scholar
  • 18 Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V. The Bernese periacetabular osteotomy: Clinical, radiographic, and mechanical 7–15 year follow-up of 26 hips. Acta Orthop 2005; 76 (06) 833-840
    CrossrefPubMedGoogle Scholar
  • 19 Siebenrock KA, Leunig M, Ganz R. Periacetabular osteotomy: the Bernese experience. Instr Course Lect 2001; 50: 239-245
    PubMedGoogle Scholar
  • 20 Trousdale RT, Cabanela ME. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthop Scand 2003; 74 (02) 119-126
    CrossrefPubMedGoogle Scholar
  • 21 Trumble SJ, Mayo KA, Mast JW. The periacetabular osteotomy. Minimum 2 year followup in more than 100 hips. Clin Orthop Relat Res 1999; (363) 54-63
    PubMedGoogle Scholar
  • 22 Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 1976; (119) 39-47
    PubMedGoogle Scholar
  • 23 Zaltz I, Baca G, Kim YJ. , et al. Complications associated with the periacetabular osteotomy: a prospective multicenter study. J Bone Joint Surg Am 2014; 96 (23) 1967-1974
    CrossrefPubMedGoogle Scholar
  • 24 Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy 2003; 19 (10) 1055-1060
    CrossrefPubMedGoogle Scholar
  • 25 Fukui K, Trindade CA, Briggs KK, Philippon MJ. Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: outcomes following hip arthroscopy for treatment of chondrolabral damage. Bone Joint J 2015; 97-B (10) 1316-1321
    CrossrefPubMedGoogle Scholar
  • 26 Davey JP, Santore RF. Complications of periacetabular osteotomy. Clin Orthop Relat Res 1999; (363) 33-37
    PubMedGoogle Scholar
  • 27 Hussell JG, Rodriguez JA, Ganz R. Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res 1999; (363) 81-92
    PubMedGoogle Scholar
  • 28 Kain MSH, Novais EN, Vallim C, Millis MB, Kim YJ. Periacetabular osteotomy after failed hip arthroscopy for labral tears in patients with acetabular dysplasia. J Bone Joint Surg Am 2011; 93 (Suppl. 02) 57-61
    PubMedGoogle Scholar
  • 29 Ziebarth K, Balakumar J, Domayer S, Kim YJ, Millis MB. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?. Clin Orthop Relat Res 2011; 469 (02) 447-453
    CrossrefPubMedGoogle Scholar
  • 30 Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 2008; 466 (07) 1633-1644
    CrossrefPubMedGoogle Scholar