Clinical Orthopaedics and Related Research®

, Volume 470, Issue 11, pp 2978–2987 | Cite as

What Factors Predict Failure 4 to 12 Years After Periacetabular Osteotomy?

  • Charlotte Hartig-Andreasen
  • Anders Troelsen
  • Theis Muncholm Thillemann
  • Kjeld Søballe
Symposium: Papers Presented at the 2011 Meeting of the International Hip Society



The goal of periacetabular osteotomy (PAO) is to delay or prevent osteoarthritic development in dysplastic hips. However, it is unclear whether the surgical goals are achieved and if so in which patients. This information is essential to select appropriate patients for a durable PAO that achieves its goals.


We therefore (1) determined hip survival rates; (2) determined how many preserved hips were functionally unsuccessful after PAO; and (3) identified demographic, clinical, and radiographic factors predicting failure after PAO.


We retrospectively reviewed 316 patients (401 hips) who had PAO between December 1998 and May 2007. We evaluated radiographic parameters of dysplasia and osteoarthritis and obtained WOMAC scores. Through inquiry to the National Registry of Patients, we identified conversions to THA. Risk factors for conversion to THA were assessed. Minimum followup was 4 years (mean, 8 years; range, 4–12 years).


The overall Kaplan-Meier hip survival rate was 74.8% at 12.4 years. A WOMAC pain score of 10 or more, suggesting clinical failure, was observed in 13% of preserved hips at last followup. Higher age, preoperative Tönnis grade of 2, incongruent hip, postoperative joint space width of 3 mm or less, and postoperative center-edge angle of less than 30° or more than 40° predicted conversion to THA.


PAO preserved three of four hips with most functioning well at 4- to 12-year followup. When planning surgery, surgeons should attempt to achieve hip congruence and a center-edge angle of between 30° to 40° to improve the durability of PAO.

Level of Evidence

Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.


Femoral Head Joint Space Width Periacetabular Osteotomy WOMAC Pain Score Crude Hazard Ratio 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Dr. Søren Overgaard, who performed some of the PAOs until 2003.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Charlotte Hartig-Andreasen
    • 1
  • Anders Troelsen
    • 2
  • Theis Muncholm Thillemann
    • 3
  • Kjeld Søballe
    • 3
  1. 1.Orthopaedic Research UnitAarhus University HospitalAarhus CDenmark
  2. 2.Department of OrthopaedicsHvidovre HospitalHvidovreDenmark
  3. 3.Department of OrthopaedicsAarhus University HospitalAarhusDenmark

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