Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1602–1614

Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH

  • Christoph E. Albers
  • Simon D. Steppacher
  • Reinhold Ganz
  • Moritz Tannast
  • Klaus A. Siebenrock
Clinical Research

DOI: 10.1007/s11999-013-2799-8

Cite this article as:
Albers, C.E., Steppacher, S.D., Ganz, R. et al. Clin Orthop Relat Res (2013) 471: 1602. doi:10.1007/s11999-013-2799-8

Abstract

Background

Although periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) provides conceptual advantages compared with other osteotomies and reportedly is associated with joint survivorship of 60% at 20 years, the beneficial effect of proper acetabular reorientation with concomitant arthrotomy and creation of femoral head-neck offset on 10-year hip survivorship remains unclear.

Questions/purposes

We asked the following questions: (1) Does the 10-year survivorship of the hip after PAO improve with proper acetabular reorientation and a spherical femoral head; (2) does the Merle d’Aubigné-Postel score improve; (3) can the progression of osteoarthritis (OA) be slowed; and (4) what factors predict conversion to THA, progression of OA, or a Merle d’Aubigné-Postel score less than 15 points?

Methods

We retrospectively reviewed 147 patients who underwent 165 PAOs for DDH with two matched groups: Group I (proper reorientation and spherical femoral head) and Group II (improper reorientation and aspherical femoral head). We compared the Kaplan-Meier survivorship, Merle d’Aubigné-Postel scores, and progression of OA in both groups. A Cox regression analysis (end points: THA, OA progression, or Merle d’Aubigné-Postel score less than 15) was performed to detect factors predicting failure. The minimum followup was 10 years (median, 11 years; range, 10–14 years).

Results

An increased survivorship was found in Group I. The Merle d’Aubigné-Postel score did not differ. Progression of OA in Group I was slower than in Group II. Factors predicting failure included greater age, lower preoperative Merle d’Aubigné-Postel score, and the presence of a Trendelenburg sign, aspherical head, OA, subluxation, postoperative acetabular retroversion, excessive acetabular anteversion, and undercoverage.

Conclusions

Proper acetabular reorientation and the creation of a spherical femoral head improve long-term survivorship and decelerate OA progression in patients with DDH.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Christoph E. Albers
    • 1
  • Simon D. Steppacher
    • 1
  • Reinhold Ganz
    • 2
  • Moritz Tannast
    • 1
  • Klaus A. Siebenrock
    • 1
  1. 1.Department of Orthopedic SurgeryInselspital, University of BernBernSwitzerland
  2. 2.Emeritus, Faculty of MedicineUniversity of BernBernSwitzerland