Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1602–1614 | Cite as

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

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.

Notes

Acknowledgments

We thank Joseph M. Schwab MD for assistance with preparation of this article.

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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

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