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Der Orthopäde

, Volume 47, Issue 3, pp 228–237 | Cite as

Periazetabuläre Osteotomie – Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse?

Eine prospektive 5‑Jahres-Untersuchung
  • L. Franken
  • F. Thielemann
  • A. Postler
  • S. Blum
  • A. Hartmann
  • K.-P. Günther
  • J. Goronzy
Originalien

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.

Schlüsselwörter

Patientenselektion Beckenosteotomie Hüftdysplasie Arthrose Lebensqualität 

Abkürzungen

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

Periacetabular osteotomy—what influence does age have on patient-relevant results?

A prospective 5‑year investigation

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.

Keywords

Patient selection Pelvic osteotomy Hip dysplasia Arthrosis Quality of life 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

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.

Literatur

  1. 1.
    Agricola R, Heijboer MP, Roze RH et al (2013) Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study (CHECK). Osteoarthr Cartil 21:1514–1521CrossRefPubMedGoogle Scholar
  2. 2.
    Beaule PE, Dowding C, Parker G et al (2015) What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy? Clin Orthop Relat Res 473:615–622CrossRefPubMedGoogle Scholar
  3. 3.
    Bernstein P, Thielemann F, Gunther KP (2007) A modification of periacetabular osteotomy using a two-incision approach. Open Orthop J 1:13–18CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Clohisy JC, Ackerman J, Baca G et al (2017) Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study. J Bone Joint Surg Am 99:33–41CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dahl LB, Dengsø K, Bang-Christiansen K et al (2018) Clinical and Radiological Outcome after Periacetabular Osteotomy: A Cross-Sectional Study of 127 Hips Operated on from 1999–2008. HIP International 24(4):369–380CrossRefGoogle Scholar
  6. 6.
    d’Aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36-A:451–475CrossRefPubMedGoogle Scholar
  7. 7.
    Dawson J, Fitzpatrick R, Carr A et al (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 78:185–190CrossRefPubMedGoogle Scholar
  8. 8.
    Díaz BA, Peréz RL, Bullón IG et al (2015) Long-term clinical and radiological outcomes in a serie of 26 cases of symptomatic adult developmental dysplasia of the hip managed with bernese periacetabular osteotomy. Rev Esp Cir Ortop Traumatol 59:421–428Google Scholar
  9. 9.
    Fujii M, Nakashima Y, Yamamoto T et al (2011) Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. Bone Joint J 93-B(11):1449–1456CrossRefGoogle Scholar
  10. 10.
    Ganz R, Klaue K, Vinh TS et al (1988) A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res.  https://doi.org/10.1097/00003086-198807000-00006 Google Scholar
  11. 11.
    Ganz R, Klaue K, Mast J (1990) Peri-acetabular reorientation osteotomy. Acta Orthop Belg 56:357–369PubMedGoogle Scholar
  12. 12.
    Garras DN, Crowder TT, Olson SA (2007) Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone and Joint Surgery – British Volume 89-B(6):721–724CrossRefGoogle Scholar
  13. 13.
    Goronzy J, Franken L, Hartmann A et al (2017) What are the results of surgical treatment of hip dysplasia with concomitant cam deformity? Clin Orthop Relat Res 475:1128–1137CrossRefPubMedGoogle Scholar
  14. 14.
    Grammatopoulos G, Wales J, Kothari A et al (2016) What is the early/mid-term survivorship and functional outcome after Bernese periacetabular osteotomy in a pediatric surgeon practice? Clin Orthop Relat Res 474:1216–1223CrossRefPubMedGoogle Scholar
  15. 15.
    Hailer NP, Soykaner L, Ackermann H et al (2005) Triple osteotomy of the pelvis for acetabular dysplasia: age at operation and the incidence of nonunions and other complications influence outcome. J Bone Joint Surg Br 87:1622–1626CrossRefPubMedGoogle Scholar
  16. 16.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755CrossRefPubMedGoogle Scholar
  17. 17.
    Hartig-Andreasen C, Troelsen A, Thillemann TM et al (2012) What factors predict failure 4 to 12 years after periacetabular osteotomy? Clin Orthop Relat Res 470:2978–2987CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    van Hellemondt GG (2005) Triple osteotomy of the pelvis for acetabular dysplasia: Results at a mean follow-up of 15 years. J Bone and Joint Surgery – British Volume 87-B(7):911–915CrossRefGoogle Scholar
  19. 19.
    Hinz A, Klaiberg A, Brahler E et al (2006) The quality of life questionnaire EQ-5D: modelling and norm values for the general population. Psychother Psychosom Med Psychol 56:42–48CrossRefPubMedGoogle Scholar
  20. 20.
    Impellizzeri FM, Mannion AF, Naal FD et al (2012) The early outcome of surgical treatment for femoroacetabular impingement: success depends on how you measure it. Osteoarthr Cartil 20:638–645CrossRefPubMedGoogle Scholar
  21. 21.
    Ito H, Tanino H, Yamanaka Y et al (2011) Intermediate to long-term results of periacetabular osteotomy in patients younger and older than forty years of age. J Bone Joint Surg Am 93:1347–1354CrossRefPubMedGoogle Scholar
  22. 22.
    Jager M, Westhoff B, Zilkens C et al (2008) Indications and results of corrective pelvic osteotomies in developmental dysplasia of the hip. Orthopäde 37(6):556–576CrossRefPubMedGoogle Scholar
  23. 23.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Khan OH, Malviya A, Subramanian P et al (2017) Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J 99-B:22–28CrossRefPubMedGoogle Scholar
  25. 25.
    Kirschner S, Raab P, Wild A et al (2002) Kurz- bis mittelfristige klinische und radiologische Ergebnisse mit der dreifachen Beckenosteotomie nach Tönnis im Jugend- und Erwachsenenalter. Zeitschrift für Orthopädie und ihre Grenzgebiete 140(05):523–526CrossRefPubMedGoogle Scholar
  26. 26.
    de Kleuver M, Kooijman MA, Pavlov PW et al (1997) Triple osteotomy of the pelvis for acetabular dysplasia: results at 8 to 15 years. J Bone Joint Surg Br 79:225–229CrossRefPubMedGoogle Scholar
  27. 27.
    Kolb A, Windhager R, Chiari C (2015) Congenital hip dysplasia, screening and therapy. Orthopäde 44:917–926CrossRefPubMedGoogle Scholar
  28. 28.
    Kralj M, Mavcic B, Antolic V et al (2005) The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7–15-year follow-up of 26 hips. Acta Orthop 76:833–840CrossRefPubMedGoogle Scholar
  29. 29.
    Lerch TD, Steppacher SD, Liechti EF et al (2016) Bernese periacetabular osteotomy: indications, technique and results 30 years after the first description. Orthopäde 45:687–694CrossRefPubMedGoogle Scholar
  30. 30.
    Lerch TD, Steppacher SD, Liechti EF et al (2017) One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res 475:1154–1168CrossRefPubMedGoogle Scholar
  31. 31.
    Maruyama M, Wakabayashi S, Tensho K (2013) Less invasive rotational acetabular osteotomy for hip dysplasia. Clin Orthop Relat Res 471:1263–1270CrossRefPubMedGoogle Scholar
  32. 32.
    Maruyama M, Wakabayashi S, Tensho K (2013) Less Invasive Rotational Acetabular Osteotomy for Hip Dysplasia. Clinical Orthopaedics and Related Res 471(4):1263–1270CrossRefGoogle Scholar
  33. 33.
    Matheney T, Kim YJ, Zurakowski D et al (2009) Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am 91:2113–2123CrossRefPubMedGoogle Scholar
  34. 34.
    Mechlenburg I, Nyengaard JR, Gelineck J et al (2015) Cartilage thickness and cyst volume are unchanged 10 years after periacetabular osteotomy in patients without hip symptoms. Clin Orthop Relat Res 473:2644–2649CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Millis MB, Kain M, Sierra R et al (2009) Periacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study. Clin Orthop Relat Res 467:2228–2234CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Nakamura S, Ninomiya S, Takatori Y et al (1998) Long-term outcome of rotational acetabular osteotomy: 145 hips followed for 10–23 years. Acta Orthop Scand 69:259–265CrossRefPubMedGoogle Scholar
  37. 37.
    Notzli HP, Wyss TF, Stoecklin CH et al (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84:556–560CrossRefPubMedGoogle Scholar
  38. 38.
    Nozawa M, Shitoto K, Matsuda K et al (2002) Rotational acetabular osteotomy for acetabular dysplasia. A follow-up for more than ten years. J Bone Joint Surg Br 84:59–65CrossRefPubMedGoogle Scholar
  39. 39.
    Okano K, Enomoto H, Osaki M et al (2008) Outcome of rotational acetabular osteotomy for early hip osteoarthritis secondary to dysplasia related to femoral head shape: 49 hips followed for 10–17 years. Acta Orthop 79:12–17CrossRefPubMedGoogle Scholar
  40. 40.
    Schramm M, Hohmann D, Radespiel-Troger M et al (2003) Treatment of the dysplastic acetabulum with Wagner spherical osteotomy. A study of patients followed for a minimum of twenty years. J Bone Joint Surg Am 85-A:808–814CrossRefPubMedGoogle Scholar
  41. 41.
    Graf von der Schulenburg JM, Claes C, Greiner W et al (1998) Die deutsche Version des EuroQol-Fragenbogens – The German Version of the EuroQol Questionnaire. Z Gesundh Wiss.  https://doi.org/10.1007/bf02956350 Google Scholar
  42. 42.
    Siebenrock KA, Scholl E, Lottenbach M et al (1999) Bernese periacetabular osteotomy. Clin Orthop Relat Res.  https://doi.org/10.1097/00003086-199906000-00003 Google Scholar
  43. 43.
    Steppacher SD, Tannast M, Ganz R et al (2008) Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 466:1633–1644CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    van Stralen RA, van Hellemondt GG, Ramrattan NN et al (2013) Can a Triple Pelvic Osteotomy for Adult Symptomatic Hip Dysplasia Provide Relief of Symptoms for 25 Years? Clinical Orthopaedics and Related Res 471(2):584–590CrossRefGoogle Scholar
  45. 45.
    Stucki G, Meier D, Stucki S et al (1996) Evaluation of a German version of WOMAC (Western Ontario and McMaster universities) arthrosis index. Z Rheumatol 55:40–49PubMedGoogle Scholar
  46. 46.
    Sun W, Shi ZC, Li ZR et al (2013) Rotational Acetabular Osteotomy through an Ollier Lateral U Approach for Early-stage Osteoarthritis Secondary to Acetabular Dysplasia. Orthopaedic Surgery 5(1):18–22CrossRefPubMedGoogle Scholar
  47. 47.
    Teratani T, Naito M, Kiyama T et al (2010) Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am 92:31–41CrossRefPubMedGoogle Scholar
  48. 48.
    Thomas GE, Palmer AJ, Batra RN et al (2014) Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20 year longitudinal cohort study. Osteoarthr Cartil 22:1504–1510CrossRefPubMedGoogle Scholar
  49. 49.
    Troelsen A, Elmengaard B, Soballe K (2009) Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am 91:2169–2179CrossRefPubMedGoogle Scholar
  50. 50.
    Wells J, Millis M, Kim YJ et al (2017) Survivorship of the Bernese periacetabular osteotomy: What factors are associated with long-term failure? Clin Orthop Relat Res 475:396–405CrossRefPubMedGoogle Scholar
  51. 51.
    Wiberg G (1939) The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand 83:7–38Google Scholar
  52. 52.
    Wyles CC, Heidenreich MJ, Jeng J et al (2017) The John Charnley award: redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clin Orthop Relat Res 475:336–350CrossRefPubMedGoogle Scholar
  53. 53.
    Yasunaga Y, Yamasaki T, Ochi M (2012) Patient selection criteria for periacetabular osteotomy or rotational acetabular osteotomy. Clin Orthop Relat Res 470:3342–3354CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Yasunaga Y, Ochi M, Yamasaki T et al (2016) Rotational Acetabular osteotomy for pre- and early osteoarthritis secondary to dysplasia provides durable results at 20 years. Clin Orthop Relat Res 474:2145–2153CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Zahedi AR, Luring C, Janssen D (2016) Tonnis and Kalchschmidt triple pelvic osteotomy. Orthopäde 45:673–677CrossRefPubMedGoogle Scholar
  56. 56.
    Zhu J, Chen X, Cui Y et al (2013) Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients. International Orthopaedics 37(4):589–594CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Ziegler J, Thielemann F, Mayer-Athenstaedt C et al (2008) The natural history of developmental dysplasia of the hip. A meta-analysis of the published literature. Orthopäde 37:515–524CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • L. Franken
    • 1
  • F. Thielemann
    • 1
  • A. Postler
    • 1
  • S. Blum
    • 2
  • A. Hartmann
    • 1
  • K.-P. Günther
    • 1
  • J. Goronzy
    • 1
  1. 1.UniversitätsCentrum für Orthopädie & Unfallchirurgie am Universitätsklinikum Carl Gustav Carus Dresden, Medizinische FakultätTechnische Universität DresdenDresdenDeutschland
  2. 2.Institut und Poliklinik für Radiologische Diagnostik am Universitätsklinikum Carl Gustav Carus Dresden, Medizinische FakultätTechnische Universität DresdenDresdenDeutschland

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