Skip to main content
SpringerLink
Log in

Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C
Fig. 2
Fig. 3
Fig. 4A–D
Fig. 5A–F

Similar content being viewed by others

References

  1. Apley AG, Wientroub S. The sagging rope sign in Perthes’ disease and allied disorders. J Bone Joint Surg Br. 1981;63:43–47.

    PubMed  Google Scholar 

  2. Cox DR. Regression models and life-tables. J Roy Stat Soc B. 1972;34:187–191.

    Google Scholar 

  3. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.

    PubMed  Google Scholar 

  4. de Kleuver M, Kapitein PJ, Kooijman MA, van Limbeek J, Pavlov PW, Veth RP. Acetabular coverage of the femoral head after triple pelvic osteotomy: no relation to outcome in 51 hips followed for 8–15 years. Acta Orthop Scand. 1999;70:583–588.

    Article  PubMed  Google Scholar 

  5. de Kleuver M, Kooijman MA, Pavlov PW, Veth RP. Triple osteotomy of the pelvis for acetabular dysplasia: results at 8 to 15 years. J Bone Joint Surg Br. 1997;79:225–229.

    Article  PubMed  Google Scholar 

  6. Eijer H, Leunig M, Mohamed N, Ganz R. Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int. 2001;11:37–41.

    Google Scholar 

  7. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36.

    PubMed  Google Scholar 

  8. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.

    PubMed  Google Scholar 

  9. Golub BS. The Duchenne-Trendelenburg sign. Bull Hosp Joint Dis. 1947;8:127–136.

    PubMed  CAS  Google Scholar 

  10. Hananouchi T, Yasui Y, Yamamoto K, Toritsuka Y, Ohzono K. Anterior impingement test for labral lesions has high positive predictive value. Clin Orthop Relat Res. 2012;470:3524–3529.

    Article  PubMed  Google Scholar 

  11. Hartig-Andreasen C, Troelsen A, Thillemann TM, Soballe K. What factors predict failure 4 to 12 years after periacetabular osteotomy? Clin Orthop Relat Res. 2012;470:2978–2987.

    Article  PubMed  Google Scholar 

  12. Hipp JA, Sugano N, Millis MB, Murphy SB. Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res. 1999;364:134–143.

    Article  PubMed  Google Scholar 

  13. Holm I, Bolstad B, Lutken T, Ervik A, Rokkum M, Steen H. Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Physiother Res Int. 2000;5:241–248.

    Article  PubMed  CAS  Google Scholar 

  14. Hsieh PH, Shih CH, Lee PC, Yang WE, Lee ZL. A modified periacetabular osteotomy with use of the transtrochanteric exposure. J Bone Joint Surg Am. 2003;85:244–250.

    Article  PubMed  Google Scholar 

  15. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  16. Kirmit L, Karatosun V, Unver B, Bakirhan S, Sen A, Gocen Z. The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists. Clin Rehabil. 2005;19:659–661.

    Article  PubMed  Google Scholar 

  17. Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V. The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7–15-year follow-up of 26 hips. Acta Orthop. 2005;76:833–840.

    Article  PubMed  Google Scholar 

  18. Lequesne M, de Seze S. [False profile of the pelvis: a new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies][in French]. Rev Rhum Mal Osteoartic. 1961;28:643–652.

    PubMed  CAS  Google Scholar 

  19. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res. 1993;292:62–76.

    PubMed  Google Scholar 

  20. Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80.

    Article  PubMed  Google Scholar 

  21. Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009;91:2113–2123.

    Article  PubMed  Google Scholar 

  22. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–989.

    PubMed  CAS  Google Scholar 

  23. Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:93–99.

    Article  PubMed  Google Scholar 

  24. Naito M, Shiramizu K, Akiyoshi Y, Ezoe M, Nakamura Y. Curved periacetabular osteotomy for treatment of dysplastic hip. Clin Orthop Relat Res. 2005;433:129–135.

    Article  PubMed  Google Scholar 

  25. Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the rick of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.

    Article  PubMed  CAS  Google Scholar 

  26. Ohashi H, Hirohashi K, Yamano Y. Factors influencing the outcome of Chiari pelvic osteotomy: a long-term follow-up. J Bone Joint Surg Br. 2000;82:517–525.

    Article  PubMed  CAS  Google Scholar 

  27. Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res. 2010;468:504–510.

    Article  PubMed  Google Scholar 

  28. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

    Article  PubMed  CAS  Google Scholar 

  29. Siebenrock KA, Leunig M, Ganz R. Periacetabular osteotomy: the Bernese experience. Instr Course Lect. 2001;50:239–245.

    PubMed  CAS  Google Scholar 

  30. Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.

    Article  PubMed  Google Scholar 

  31. Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004:418;54–60.

    Article  PubMed  Google Scholar 

  32. Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949;31:40–46.

    Google Scholar 

  33. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644.

    Article  PubMed  Google Scholar 

  34. Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res. 2008;466:782–790.

    Article  PubMed  CAS  Google Scholar 

  35. Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The Hip. Proceedings of the 3rd Meeting of The Hip Society. St Louis, MO, USA: CV Mosby Co; 1975:212–228.

    Google Scholar 

  36. Tannast M, Albers CE, Steppacher SD, Siebenrock KA. Hip pain in the young adult. In: Bentley G, ed. European Instructional Lectures. Berlin, Germany: Springer; 2011:141–154.

    Chapter  Google Scholar 

  37. Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm: reliable and validated. J Orthop Res. 2008;26:1199–1205.

    Article  PubMed  Google Scholar 

  38. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.

    Article  PubMed  Google Scholar 

  39. Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, Siebenrock KA. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–190.

    Article  PubMed  CAS  Google Scholar 

  40. Tönnis D. General radiography of the hip joint. In: Tönnis D, ed. Congenital Dysplasia, Dislocation of the Hip. New York, NY, USA: Springer; 1987:100–142.

    Chapter  Google Scholar 

  41. Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.

    PubMed  CAS  Google Scholar 

  42. Troelsen A, Elmengaard B, Soballe K. A new minimally invasive transsartorial approach for periacetabular osteotomy. J Bone Joint Surg Am. 2008;90:493–498.

    Article  PubMed  CAS  Google Scholar 

  43. Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am. 2009;91:2169–2179.

    Article  PubMed  Google Scholar 

  44. van Hellemondt GG, Sonneveld H, Schreuder MH, Kooijman MA, de Kleuver M. Triple osteotomy of the pelvis for acetabular dysplasia: results at a mean follow-up of 15 years. J Bone Joint Surg Br. 2005;87:911–915.

    Article  PubMed  Google Scholar 

  45. Weber M, Ganz R. The Bernese periacetabular osteotomy. Operat Orthop Traumatol. 2002;2:99–121.

    Article  Google Scholar 

  46. Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand. 1939;83:7–38.

    Google Scholar 

  47. Xie J, Naito M, Maeyama A. Evaluation of acetabular versions after a curved periacetabular osteotomy for dysplastic hips. Int Orthop. 2010;34:473–477.

    Article  PubMed  Google Scholar 

  48. Yanagimoto S, Hotta H, Izumida R, Sakamaki T. Long-term results of Chiari pelvic osteotomy in patients with developmental dysplasia of the hip: indications for Chiari pelvic osteotomy according to disease stage and femoral head shape. J Orthop Sci. 2005;10:557–563.

    Article  PubMed  Google Scholar 

  49. Zheng G, Tannast M, Anderegg C, Siebenrock KA, Langlotz F. Hip2Norm: an object-oriented cross-platform program for 3D analysis of hip joint morphology using 2D pelvic radiographs. Comput Methods Programs Biomed. 2007;87:36–45.

    Article  PubMed  CAS  Google Scholar 

  50. Ziebarth K, Balakumar J, Domayer S, Kim YJ, Millis MB. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2011;469:447–453.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Christoph E. Albers MD, Simon D. Steppacher MD, Moritz Tannast MD & Klaus A. Siebenrock MD

  2. Emeritus, Faculty of Medicine, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Reinhold Ganz MD

Authors
  1. Christoph E. Albers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simon D. Steppacher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reinhold Ganz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moritz Tannast MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Klaus A. Siebenrock MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simon D. Steppacher MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Albers, C.E., Steppacher, S.D., Ganz, R. et al. Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH. Clin Orthop Relat Res 471, 1602–1614 (2013). https://doi.org/10.1007/s11999-013-2799-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-2799-8

Keywords

Search

Navigation