Zusammenfassung
Hintergrund
Die periazetabuläre Osteotomie (PAO) ist ein effektives Verfahren zur Behandlung der symptomatischen Hüftdysplasie. Voraussetzung für ein gutes Therapieergebnis ist eine angemessene Patientenselektion. Ziel dieser Untersuchung ist, den Einfluss des Patientenalters zum Operationszeitpunkt auf das klinische Ergebnis zu prüfen.
Studiendesign
In einer prospektiven Kohortenstudie wurde bei 86 Patienten (106 Hüften) das klinische und radiologische Ergebnis durchschnittlich 5 Jahre nach PAO evaluiert sowie der Einfluss des Alters auf den Operationserfolg untersucht. Dazu erfolgten eine prä- und postoperative Erhebung patientenrelevanter Outcomes sowie eine radiologische Beurteilung von erfolgter Korrektur und Arthroseentwicklung. Die Patienten wurden in 4 Alterskategorien eingeteilt.
Ergebnisse
Fünf Jahre postoperativ waren 90 % der Patienten mit dem Operationsergebnis „sehr zufrieden“ oder „zufrieden“, und in allen Altersgruppen konnte eine signifikante Verbesserung der PRO erzielt werden. Zwischen den Alterskategorien zeigten sich zwar relevante Unterschiede in der Algofunktion, aber sowohl die Höhe der erreichbaren Gesamtverbesserung im WOMAC als auch die Entwicklung der gesundheitsbezogenen Lebensqualität sind in allen Altersgruppen gleich. Ein höheres Alter ist mit vermehrter Arthroseprogredienz sowie Konversion in Totalendoprothesen assoziiert.
Diskussion
Das Lebensalter ist ein wichtiger Einflussfaktor für den langfristigen Erfolg der PAO. Eine absolute Altersgrenze konnte in diesem Kollektiv nicht nachgewiesen werden. Auch Patienten aus den Alterskategorien „30–39 Jahre“ und „> 40 Jahre“ haben im mittelfristigen Beobachtungszeitraum von der Operation hinsichtlich Algofunktion sowie gesundheitsbezogener Lebensqualität profitiert und waren mit dem Behandlungsergebnis zufrieden. Bei jedoch erhöhter Arthroseprogredienz und Konversionsrate im zunehmenden Alter sollten die Erfolgsaussichten der Operation ausführlich mit dem Patienten diskutiert und nicht nur das Lebensalter des Patienten, sondern vielmehr das biologische Alter des Hüftgelenks berücksichtigt werden.
Abstract
Introduction
Periacetabular osteotomy (PAO) is an effective procedure in treatment of symptomatic hip dysplasia. To achieve a good outcome a strict patient selection has to be applied. The aim of this study was to evaluate the influence of patient age at surgery on clinical outcome.
Methods
In a prospective study 86 patients (106 hips) underwent clinical and radiographic follow-up at a mean time of 5 years (2.5–8.5 years) after PAO. Patient-related outcome measurements (PROMs: EQ-5D, WOMAC, OHS, GTO) were applied preoperatively as well as postoperatively and the deformity correction as well as development of osteoarthritis were evaluated. In order to analyze the influence of patient age at surgery on clinical outcome, we subdivided the patient cohort into four different age groups (<20 years, 20–29 years, 30–39 years, >40 years).
Results
Of the patients 90% were very satisfied or satisfied with the results 5 years after surgery, and in all age groups PROMs significantly increased. Even though preoperative as well as postoperative algofunction declined in cohorts with increasing age, the overall benefit as measured in WOMAC and EQ-5D scores was equal in all age groups. Increasing age is associated with a progression in osteoarthritis as well as a higher conversion rate to total arthroplasty.
Discussion
Age is an important influencing factor on the long-term outcome after PAO. A certain age as cut off for indications could not be identified in this study. Even patients in the age groups 30–39 years and > 40 years showed PROM improvement and satisfaction with outcome at medium-term follow-up. The expected success rate has to be discussed preoperatively with the patient; however, as a higher conversion rate to hip arthroplasty as well as progressive osteoarthritis is associated with higher age, not only patient age alone but also morphological characteristics of the hip joint have to be taken into consideration.
Abbreviations
- BMI:
-
Body-Mass-Index
- EQ-5D:
-
EuroQol – 5 Dimensionen
- FAI:
-
femoroazetabuläres Impingement
- f/u:
-
Follow-up
- GTO:
-
Global Treatment Outcome
- HHS:
-
Harris Hip Score
- HOOS:
-
Hip Disability and Osteoarthritis Outcome Score
- JOA:
-
Japanese Orthopaedic Association Hip Score
- LCE-Winkel:
-
lateraler Zentrum-Erker-Winkel
- MdA:
-
Merle d’Aubigné-Postel Score
- MW:
-
Mittelwert
- NAHS:
-
Non Arthritic Hip Score
- OA:
-
Osteoarthrose
- OHS:
-
Oxford Hip Score
- PAO:
-
periazetabuläre Osteotomie
- PRO:
-
patientenrelevantes Outcome
- PROMs:
-
Patient-related outcome measurements
- RAO:
-
„rotational acetabular osteotomy“
- SD:
-
Standardabweichung
- SF-12:
-
Short Form 12
- TAO:
-
„transposition osteotomy of the acetabulum“
- TEP:
-
Totalendoprothese
- THA:
-
Total Hip Arthroplasty
- UCLA:
-
University of California Los Angeles Activity Score
- VAS:
-
visuelle Analogskala
- WOMAC:
-
Western Ontario and McMaster Universities Osteoarthritis Index
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L. Franken, F. Thielemann, A. Postler, S. Blum, A. Hartmann, K.-P. Günther und J. Goronzy geben an, dass kein Interessenkonflikt besteht.
Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
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L. Franken und F. Thielemann teilen sich die Erstautorenschaft.
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Franken, L., Thielemann, F., Postler, A. et al. Periazetabuläre Osteotomie – Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse?. Orthopäde 47, 228–237 (2018). https://doi.org/10.1007/s00132-017-3523-2
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DOI: https://doi.org/10.1007/s00132-017-3523-2