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Periacetabular Osteotomy for Acetabular Dysplasia in Patients Older than 40 Years: A Preliminary Study

  • Symposium: Papers Presented at the Annual Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

The functional outcomes of periacetabular osteotomy (PAO) and factors predicting outcome in the older patient with acetabular dysplasia are not well understood. We therefore retrospectively determined the functional outcome of 70 patients (87 hips) over age 40 treated with PAO in three institutions; we also determined whether preoperative factors, particularly the presence of osteoarthritis, influenced the survival of the hip or time to total hip arthroplasty after PAO. The average age at surgery was 43.6 years. The minimum followup was 2 years (mean, 4.9 years; range, 2–13 years). Twenty-one hips (24%) had undergone total hip arthroplasty (THA), at a mean of 5.2 years after PAO (range, 1.9–7.6 years). Surviving hips had a mean improvement in Harris hip score from 60.7 to 90.3 and in total WOMAC pain score from 8.7 to 3. We observed no differences in preoperative or postoperative radiographic measurements or preoperative clinical function scores (HHS, WOMAC) in hips surviving and hips having THA. The risk of THA at 5 years after PAO was 12% in hips with preoperative Tönnis Grade 0 or 1 and 27% for Tönnis Grade 2. Our preliminary study suggests that PAO will give satisfactory functional and pain scores in patients over age 40 having dysplastic hips with mild or no arthrosis.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Biedermann R, Donnan L, Gabriel A, Wachter R, Krismer M, Behensky H. Complications and patient satisfaction after periacetabular pelvic osteotomy. Int Orthop. 2008;32:611–617. Epub 2007 Jun 20.

    Article  PubMed  CAS  Google Scholar 

  2. Crockarell J Jr, 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.

    Article  PubMed  Google Scholar 

  3. Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006;88:1540–1548.

    Article  PubMed  Google Scholar 

  4. Garbuz DS, Awwad MA, Duncan CP. Periacetabular osteotomy and total hip arthroplasty in patients older than 40 years. J Arthroplasty. 2008;23:960–963. Epub 2008 Mar 14.

    Article  PubMed  Google Scholar 

  5. Garras DN, Crowder TT, Olson SA. Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg Br. 2007;89:721–724.

    Article  PubMed  CAS  Google Scholar 

  6. Kim YJ, Jaramillo D, Millis MB, Gray ML, Burstein D. Assessment of early osteoarthritis in hip dysplasia with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. J Bone Joint Surg Am. 2003;85:1987–1992.

    Article  PubMed  Google Scholar 

  7. 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;76:833–840.

    Article  PubMed  Google Scholar 

  8. Lequesne M, deSeze S. 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.

    PubMed  CAS  Google Scholar 

  9. Matheney TH, Kim Y-J, Zurakowski D, Matero C, Millis MB. Mid to long-term results of Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009, in press.

  10. Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res. 1999;363:21–32.

    PubMed  Google Scholar 

  11. Millis MB, Murphy SB. The Boston concept. peri-acetabular osteotomy with simultaneous arthrotomy via direct anterior approach [in German]. Orthopade. 1998;27:751–758.

    PubMed  CAS  Google Scholar 

  12. Murphy SB, Millis MB. Periacetabular osteotomy without abductor dissection using direct anterior exposure. Clin Orthop Relat Res. 1999;364:92–98.

    Article  PubMed  Google Scholar 

  13. Naito M, Shiramizu K, Akiyoshi Y, Ezoe M, Nakamura Y. Curved periacetabular osteotomy for treatment of dysplastic hip. Clin Orthop Relat Res. 2005;433:129–135.

    Article  PubMed  Google Scholar 

  14. Parvizi J, Burmeister H, Ganz R. Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty. Clin Orthop Relat Res. 2004;423:118–122.

    Article  PubMed  Google Scholar 

  15. Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am. 2006;88:1920–1926.

    Article  PubMed  Google Scholar 

  16. Pogliacomi F, Stark A, Wallensten R. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years. Acta Orthop. 2005;76:67–74.

    Article  PubMed  Google Scholar 

  17. Sambandam SN, Hull J, Jiranek WA. Factors predicting the failure of Bernese periacetabular osteotomy: a meta-regression analysis. Int Orthop. 2008 Aug 22. [Epub ahead of print].

  18. Sharifi E, Sharifi H, Morshed S, Bozic K, Diab M. Cost-effectiveness analysis of periacetabular osteotomy. J Bone Joint Surg Am. 2008;90:1447–1456.

    Article  PubMed  Google Scholar 

  19. Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.

    Article  PubMed  Google Scholar 

  20. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644.

    Article  PubMed  Google Scholar 

  21. Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, NY: Springer; 1987.

    Google Scholar 

  22. Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am. 1995;77:73–85.

    PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. van Bergayk AB, Garbuz DS. Quality of life and sports-specific outcomes after Bernese periacetabular osteotomy. J Bone Joint Surg Br. 2002;84:339–343.

    Article  PubMed  Google Scholar 

  25. Wilberg G. Studies of dysplastic acetabula and congenital subluxation of the hip joint with special reference to the comlixation of osteoarthritis. Act Chir Scand (Suppl 58). 1939:7–38.

  26. Yasunaga Y, Takahashi K, Ochi M, Ikuta Y, Hisatome T, Nakashiro J, Yamamoto S. Rotational acetabular osteotomy in patients forty-six years of age or older: comparison with younger patients. J Bone Joint Surg Am. 2003;85:266–272.

    PubMed  Google Scholar 

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Acknowledgments

We thank Clarissa Valim, MD, ScD, for her assistance with the statistical analysis and Catherine Matero for her assistance with organizing the data collection. We also thank Professor Reinhold Ganz for invaluable mentoring.

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Authors and Affiliations

  1. Adolescent and Young Adult Hip Unit, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Michael B. Millis MD, Michael Kain MD, Young-Jo Kim MD, PhD & Scott B. Rosenfeld MD

  2. Washington University School of Medicine, St. Louis, MO, USA

    Ganesh Kamath MD, Perry Schoenecker MD & John C. Clohisy MD

  3. Mayo Clinic, Rochester, MN, USA

    Rafael Sierra MD, Robert Trousdale MD & Michael J. Taunton MD

Authors
  1. Michael B. Millis MD
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  2. Michael Kain MD
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  3. Rafael Sierra MD
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  4. Robert Trousdale MD
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  5. Michael J. Taunton MD
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  6. Young-Jo Kim MD, PhD
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  7. Scott B. Rosenfeld MD
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  8. Ganesh Kamath MD
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  9. Perry Schoenecker MD
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  10. John C. Clohisy MD
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Corresponding author

Correspondence to Michael B. Millis MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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

This work was performed at Children’s Hospital Boston, Boston, MA, Washington University School of Medicine, St. Louis, MO, and the Mayo Clinic, Rochester, MN.

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Millis, M.B., Kain, M., Sierra, R. et al. Periacetabular Osteotomy for Acetabular Dysplasia in Patients Older than 40 Years: A Preliminary Study. Clin Orthop Relat Res 467, 2228–2234 (2009). https://doi.org/10.1007/s11999-009-0824-8

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  • DOI: https://doi.org/10.1007/s11999-009-0824-8

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