Periacetabular Osteotomy for Acetabular Dysplasia in Patients Older than 40 Years: A Preliminary Study
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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.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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.
- 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.
- Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res. 1999;363:21–32.
- Millis MB, Murphy SB. The Boston concept. peri-acetabular osteotomy with simultaneous arthrotomy via direct anterior approach [in German]. Orthopade. 1998;27:751–758.
- Murphy SB, Millis MB. Periacetabular osteotomy without abductor dissection using direct anterior exposure. Clin Orthop Relat Res. 1999;364:92–98. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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].
- 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. CrossRef
- Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20. CrossRef
- Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644. CrossRef
- Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, NY: Springer; 1987.
- 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.
- 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. CrossRef
- 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. CrossRef
- 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.
- 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.
- Periacetabular Osteotomy for Acetabular Dysplasia in Patients Older than 40 Years: A Preliminary Study
Clinical Orthopaedics and Related Research®
Volume 467, Issue 9 , pp 2228-2234
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- 1. Adolescent and Young Adult Hip Unit, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- 3. Mayo Clinic, Rochester, MN, USA
- 2. Washington University School of Medicine, St. Louis, MO, USA