A Less Invasive Approach to Periacetabular Osteotomy Improves Patient Reported Outcomes without Compromising Orientation

Abstract

A less-invasive modification of the approach to periacetabular osteotomy (PAO) has recently been popularized by sparing the rectus femoris origin (RS-PAO). The RS-PAO approach with its lack of intra-articular inspection and associated treatment is novel, and there are few published results on the outcomes following this technique. We report on a consecutive series of RS-PAO cases, including patient reported outcomes (PROs), acetabular fragment reorientation, and complications. We reviewed a consecutive series of 103 patients (103 procedures) who underwent RS-PAO from June 2012 to January 2016 with a mean 2-year follow-up. We collected PROs, radiographic, and clinical outcomes. PROs consisted of PROMIS (Patient Reported Outcomes Measurement Information System) measures covering the domains of physical function, mental health, and a numeric pain score (NPS). Physical function and mental health were reported as standardized T-scores. Appropriate bivariate statistics were used for the analyses. Physical function improved from a preoperative mean of 39.9 (95% confidence interval [CI], 38.0–42.0) to a postoperative value of 50.0 T-score units (95% CI, 47.01–52.7; d_av = 1.2). The PROMIS global mental-health T-scores improved from a preoperative median of 45.8 (interquartile range [IQR], 41.1–50.8) to a postoperative value of 53.3 (IQR, 50.8–59.0; p < 0.001, correlation coefficient [r] = 0.77). Pain decreased from a median preoperative value of 6 (IQR, 3–8) to a postoperative value of 2 (IQR, 1–3; p < 0.001, r = 0.71). The postoperative acetabular index (AI) was within the correction goal in 75% of the cases (77/103) and lateral center-edge angle (LCEA) was within goal in 87% (90/103) of the cases. Complications included intraoperative ischial fracture (n = 1), nonunion of the superior ramus (n = 1), ischiofemoral impingement (n = 1), delayed union (n = 1), and wound dehiscence (n = 2). There have been no reoperations for intra-articular pathology. The data demonstrated that using the RS-PAO technique without concomitant intra-articular work allows for appropriate acetabular positioning as well as significant improvement in physical function, mental health, and pain with an acceptable short-term complication profile and low rate of reoperation.

Keywords

rectus-sparing periacetabular osteotomy - patient reported outcomes - acetabular reorientation - complications

Note

Each author certifies that his or her institution approved the human protocol for this investigation and all investigations were conducted in conformity with ethical principles of research. Also, informed consent for participation in the study was obtained.

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