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

Eine prospektive 5‑Jahres-Untersuchung

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

A prospective 5‑year investigation

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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.

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.

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Abbreviations

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

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Authors and Affiliations

  1. UniversitätsCentrum für Orthopädie & Unfallchirurgie am Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    L. Franken, F. Thielemann, A. Postler, A. Hartmann, K.-P. Günther &  J. Goronzy

  2. Institut und Poliklinik für Radiologische Diagnostik am Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland

    S. Blum

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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.

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L. Franken und F. Thielemann teilen sich die Erstautorenschaft.

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Franken, L., Thielemann, F., Postler, A. et al. Periazetabuläre Osteotomie – Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse?. Orthopäde 47, 228–237 (2018). https://doi.org/10.1007/s00132-017-3523-2

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