Does Previous Reconstructive Surgery Influence Functional Improvement and Deformity Correction After Periacetabular Osteotomy?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The Bernese periacetabular osteotomy (PAO) is commonly used to surgically treat residual acetabular dysplasia. However, the degree to which function and radiographic deformity are corrected in patients with more severe deformities that have undergone previous reconstructive pelvic or femoral osteotomies is unclear.
We evaluated hip pain and function, radiographic deformity correction, complications, reoperations, and early failures (conversion to THA) associated with PAO in hips treated with previous reconstructive hip surgery.
We retrospectively reviewed 63 patients who had undergone 67 PAOs after a previous reconstructive hip procedure. We compared preoperative hip scores and radiographic parameters with postoperative values at most recent followup. We recorded complications, need for nonarthroplasty revision surgery, and failures. Minimum followup was 2 years.
Five of the 67 hips (8%) were converted to THA between 24 and 118 months. The average followup for the remaining 62 hips was 60 months (range, 24–147 months). The average Harris hip score improved 11 points, and postoperatively, 83% of the hips had pain component scores of greater than 30 (none, slight, or mild pain). Radiographically, there were improvements in lateral center-edge angle (25°), anterior center-edge angle (23°), Tönnis angle (17°), and medialization of the hip center (8 mm). Complications occurred in 13 hips (19%). Seven hips (10%) underwent a subsequent surgical procedure to address residual pain or deformity.
PAO performed after previous reconstructive hip surgery improves hip function and corrects residual dysplasia deformities. These procedures are inherently more complex than primary PAO and are associated with a considerable risk of perioperative complications, reoperations, and early treatment failures.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Anderson LA, Crofoot CD, Erickson JA, Peters CL. Staged surgical dislocation and redirectional periacetabular osteotomy: a report of five cases. J Bone Joint Surg Am. 2009;91:2469–2476. CrossRef
- Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018. CrossRef
- 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. CrossRef
- Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196. CrossRef
- 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;87:254–259. CrossRef
- Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy in the treatment of severe acetabular dysplasia: surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1 pt 1):65–83. CrossRef
- Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am. 2007;89:1417–1423. CrossRef
- Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467:2041–2052. CrossRef
- Clohisy JC, St John LC, Nunley RM, Schutz AL, Schoenecker PL. Combined periacetabular and femoral osteotomies for severe hip deformities. Clin Orthop Relat Res. 2009;467:2221–2227. 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
- Davey JP, Santore RF. Complications of periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:33–37. CrossRef
- Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36.
- Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
- Harris WH. Traumatic 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 Am. 1969;51:737–755.
- Jessel RH, Zilkens C, Tiderius C, Dudda M, Mamisch TC, Kim YJ. Assessment of osteoarthritis in hips with femoroacetabular impingement using delayed gadolinium enhanced MRI of cartilage. J Magn Reson Imaging. 2009;30:1110–1115. 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. [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.
- Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res. 2004;418:48–53. CrossRef
- Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res. 1999;363:21–32.
- Mayo KA, Trumble SJ, Mast JW. Results of periacetabular osteotomy in patients with previous surgery for hip dysplasia. Clin Orthop Relat Res. 1999;363:73–80. CrossRef
- Murphy SB, Millis MB. Periacetabular osteotomy without abductor dissection using direct anterior exposure. Clin Orthop Relat Res. 1999;364:92–98. CrossRef
- Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741. CrossRef
- Sen C, Asik M, Tozun IR, Sener N, Cinar M. Kotz and Ganz osteotomies in the treatment of adult acetabular dysplasia. Int Orthop. 2003;27:78–84.
- Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20. CrossRef
- Sink EL, Beaule PE, Sucato D, Kim YJ, Millis MB, Dayton M, Trousdale RT, Sierra RJ, Zaltz I, Schoenecker P, Monreal A, Clohisy J. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am. 2011;93:1132–1136.
- Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552. CrossRef
- Thawrani D, Sucato DJ, Podeszwa DA, DeLaRocha A. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents. J Bone Joint Surg Am. 2010:92:1707–1714. CrossRef
- Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin, Germany: Springer; 1987. CrossRef
- 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
- Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Acta Chir Scand. 1939;83(suppl 58):5–135.
- Does Previous Reconstructive Surgery Influence Functional Improvement and Deformity Correction After Periacetabular Osteotomy?
Clinical Orthopaedics and Related Research®
Volume 470, Issue 2 , pp 516-524
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT, USA
- 2. Department of Orthopaedic Surgery, Children’s Hospital Boston, Boston, MA, USA
- 3. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion Campus Box 8233, St Louis, MO, 63110, USA