Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 5, pp 729–734 | Cite as

Failed periacetabular osteotomy leads to acetabular defects during subsequent total hip arthroplasty

  • Yusuke OsawaEmail author
  • Taisuke Seki
  • Yasuhiko Takegami
  • Taiki Kusano
  • Naoki Ishiguro
  • Yukiharu Hasegawa
Hip Arthroplasty



Acetabular wall defects after periacetabular osteotomy (PAO) lead to technical difficulties when performing subsequent total hip arthroplasty (THA). There is no unified consensus regarding the solution for THA socket installation after PAO. In the current study, we performed computed tomography (CT)-based simulation of socket installation and evaluated the acetabular defect following THA after PAO and after primary osteoarthritis (OA).

Patients and methods

The study group comprised 55 patients (56 hips) who underwent THA after PAO. For the control group, after matching for age, sex, and Crowe classification, we included 55 patients (56 hips) who underwent primary THA for hip dysplasia. We evaluated the anterior, posterior, and superior acetabular sector angle (ASA) and medial wall thickness (MWT) at the anatomical hip center (at the 20-mm vertical hip level from teardrop) in the study group (anatomical PAO group) and control group (primary OA group). In addition, we investigated the changes in the socket covering when the socket was positioned 10 mm above the anatomical hip center (30 mm above the teardrop; elevated osteotomy group).


All ASA and MWT values were significantly smaller in the anatomical PAO group than in the primary OA group. In particular, the individuals with a Crowe classification of II/III in the anatomical PAO group presented severe acetabular defects. However, the elevated PAO group had a significantly larger ASA compared to the anatomical PAO group, with improved socket coverings.


Acetabular defects in the anatomical hip center following THA after PAO were significantly common compared to those after primary THA. Elevation of hip joint centers as much as 10 mm is one therapeutic option in the case of severe acetabular defects following THA after PAO.


Acetabular wall defect Periacetabular osteotomy Rotational acetabular osteotomy Eccentric rotational acetabular osteotomy Total hip arthroplasty 



There is no funding source.

Compliance with ethical standards

Conflict of interest

All the authors state that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Steppacher SD, Tannast M, Ganz R, Siebenrock KA (2008) Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 466:1633–1644CrossRefGoogle Scholar
  2. 2.
    Kaneuji A, Sugimori T, Ichiseki T, Fukui K, Takahashi E, Matsumoto T (2015) Rotational acetabular osteotomy for osteoarthritis with acetabular dysplasia: conversion rate to total hip arthroplasty within twenty years and osteoarthritis progression after a minimum of twenty years. J Bone Jt Surg Am 97:726–732CrossRefGoogle Scholar
  3. 3.
    Yuasa T, Maezawa K, Kaneko K, Nozawa M (2017) Rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: a mean follow-up of 20 years. Arch Orthop Trauma Surg 137:465–469CrossRefGoogle Scholar
  4. 4.
    Hasegawa Y, Iwase T, Kitamura S, Kawasaki M, Yamaguchi J (2014) Eccentric rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: follow-up at a mean duration of twenty years. J Bone Jt Surg Am 96:1975–1982CrossRefGoogle Scholar
  5. 5.
    Peters CL, Beck M, Dunn HK (2001) Total hip arthroplasty in young adults after failed triple innominate osteotomy. J Arthroplasty 16:188–195CrossRefGoogle Scholar
  6. 6.
    Parvizi J, Burmeister H, Ganz R (2004) Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty. Clin Orthop Relat Res 423:118–122CrossRefGoogle Scholar
  7. 7.
    Hartig-Andreasen C, Stilling M, Søballe K, Thilleman TK, Troelsen A (2014) Is cup positioning challenged in hips previously treated with periacetabular osteotomy? J Arthroplasty 29:763–768CrossRefGoogle Scholar
  8. 8.
    Amanatullah DF, Stryker L, Schoenecker P et al (2015) Similar clinical outcomes for THAs with and without prior periacetabular osteotomy. Clin Orthop Relat Res 473:685–691CrossRefGoogle Scholar
  9. 9.
    Ito H, Takatori Y, Moro T, Oshima H, Oka H, Tanaka S (2015) Total hip arthroplasty after rotational acetabular osteotomy. J Arthroplasty 30:403–406CrossRefGoogle Scholar
  10. 10.
    Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Matsumoto T (2015) Does rotational acetabular osteotomy affect subsequent total hip arthroplasty? Arch Orthop Trauma Surg 135:407–415CrossRefGoogle Scholar
  11. 11.
    Osawa Y, Hasegawa Y, Seki T, Amano T, Higuchi Y, Ishiguro N (2016) Significantly poor outcomes of total hip arthroplasty after failed periacetabular osteotomy. J Arthroplasty 31:1904–1909CrossRefGoogle Scholar
  12. 12.
    Tamaki T, Oinuma K, Miura Y, Shiratsuchi H (2016) Total hip arthroplasty after previous acetabular osteotomy: Comparison of three types of acetabular osteotomy. J Arthroplasty 31:172–175CrossRefGoogle Scholar
  13. 13.
    Osawa Y, Hasegawa Y, Okura T, Morita D, Ishiguro N (2017) Total hip arthroplasty after periacetabular and intertrochanteric valgus osteotomy. J Arthroplasty 32:857–861CrossRefGoogle Scholar
  14. 14.
    Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy WJ (1996) The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Jt Surg Am 78:1004–1014CrossRefGoogle Scholar
  15. 15.
    Hasegawa Y, Iwase T, Kitamura S, Yamauchi K, Sakano S, Iwata H (2002) Eccentric rotational acetabular osteotomy for acetabular dysplasia: follow-up of one hundred and thirty-two hips for five to ten years. J Bone Jt Surg Am 84:404–410CrossRefGoogle Scholar
  16. 16.
    Ninomiya S (1989) Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult. Clin Orthop Relat Res 247:127–137Google Scholar
  17. 17.
    Yang Y, Zuo J, Liu T, Xiao J, Liu S, Gao Z (2017) Morphological analysis of true acetabulum in hip dysplasia (Crowe classes I-IV) via 3-D implantation simulation. J Bone Jt Surg Am 99:e92. CrossRefGoogle Scholar
  18. 18.
    Galea VP, Laaksonen I, Donahue GS et al (2018) Developmental dysplasia treated with cementless total hip arthroplasty utilizing high hip center reconstruction: a minimum 13-year follow-up study. J Arthroplasty 33(9):2899–2905CrossRefGoogle Scholar
  19. 19.
    Peters CL, Erickson JA, Hines JL (2006) Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Jt Surg Am 88:1920–1926CrossRefGoogle Scholar
  20. 20.
    Kim YH, Kim JS (2005) Total hip arthroplasty in adult patients who had developmental dysplasia of the hip. J Arthroplasty 20:1029–1036CrossRefGoogle Scholar
  21. 21.
    Osawa Y, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N (2018) Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy. J Orthop Sci 23:346–349CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yusuke Osawa
    • 1
    Email author
  • Taisuke Seki
    • 1
  • Yasuhiko Takegami
    • 1
  • Taiki Kusano
    • 1
  • Naoki Ishiguro
    • 1
  • Yukiharu Hasegawa
    • 2
  1. 1.Department of Orthopaedic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of RehabilitationKansai University of Welfare ScienceKashiwaraJapan

Personalised recommendations