Periacetabular osteotomy for the treatment of severe acetabular dysplasia

BACKGROUND: The optimal treatment of severe acetabular dysplasia with subluxation of the femoral head or the presence of a secondary acetabulum remains controversial. The purpose of this study was to analyze the extent of surgical correction and the early clinical results obtained with the Bernese periacetabular osteotomy for the treatment of severely dysplastic hips in adolescent and young adult patients. METHODS: Sixteen hips in thirteen patients with an average age of 17.6 years (range, 13.0 to 31.8 years) were classified as having severe acetabular dysplasia (Group IV or V according to the Severin classification). Eight hips were classified as subluxated, and eight had a secondary acetabulum. Preoperatively, all patients had hip pain and sufficient hip joint congruency on radiographs to be considered candidates for the osteotomy. All sixteen hips underwent a Bernese periacetabular osteotomy, and six of them underwent a concomitant proximal femoral osteotomy. Postoperatively, the hips were assessed radiographically to evaluate correction of deformity, healing of the osteotomy site, and progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 4.2 years postoperatively. RESULTS: Comparison of preoperative and follow-up radiographs demonstrated an average improvement of 44.6 degrees (from -20.5 degrees to 24.1 degrees ) in the lateral center-edge angle of Wiberg, an average improvement of 51.0 degrees (from -25.4 degrees to 25.6 degrees ) in the anterior center-edge angle of Lequesne and de Seze, and an average improvement of 25.9 degrees (from 37.3 degrees to 11.4 degrees ) in acetabular roof obliquity. The hip center was translated medially an average of 10 mm (range, 0 to 31 mm). All iliac osteotomy sites healed. The average Harris hip score improved from 73.4 points preoperatively to 91.3 points at the time of the latest follow-up. Eleven of the thirteen patients (fourteen of the sixteen hips) were satisfied with the result of the surgery, and fourteen hips had a good or excellent clinical result. Major complications included loss of acetabular fixation, which required an additional surgical procedure, in one patient and overcorrection of the acetabulum and an associated ischial nonunion in another patient. Both patients had a good clinical result at the time of the latest follow-up. There were no major neurovascular injuries or intra-articular fractures. CONCLUSIONS: The periacetabular osteotomy is an effective technique for surgical correction of a severely dysplastic acetabulum in adolescents and young adults. In this series, the early clinical results were very good at an average of 4.2 years postoperatively; the two major complications did not compromise the good clinical results.     

Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center

BACKGROUND: Most reports on the results of the Bernese periacetabular osteotomy for the treatment of developmental dysplasia of the hip have been by the originators of the procedure. In 1997, we began to use this osteotomy without direct training from the originators of the procedure. METHODS: Seventy-three patients (eighty-three hips) underwent a Bernese periacetabular osteotomy between 1997 and 2003 and were followed prospectively with use of the Harris hip score to assess clinical results and with use of anteroposterior pelvic and false-profile lateral plain radiographs to assess radiographic results. The three-dimensional position of the acetabulum was recorded preoperatively and postoperatively. The mean duration of follow-up was forty-six months. RESULTS: The average Harris hip score improved from 54 to 87 points (p < 0.001). Three hips (three patients) had a conversion to total hip arthroplasty at two, three, and four years after the periacetabular osteotomy. Preoperatively, fifty-four of the eighty-three acetabula were anteverted, and twenty-nine were either retroverted or had neutral wall relationships. Postoperatively, sixty-five hips (78%) were anteverted. Radiographically, in preoperatively anteverted hips, the average center-edge angle improved from 3 degrees to 29 degrees (p < 0.0001), the average anterior center-edge angle improved from 5 degrees to 31 degrees (p < 0.0001), and the acetabular index improved from 25 degrees to 5 degrees (p < 0.0001). In preoperatively retroverted or neutral hips, the average center-edge angle improved from 13 degrees to 33 degrees (p < 0.0001), the average anterior center-edge angle improved from 15 degrees to 36 degrees (p < 0.0001), and the acetabular index improved from 19 degrees to 2 degrees (p < 0.0001). Complications included four hematomas, three transient femoral nerve palsies, two deep wound infections, and one transient sciatic nerve palsy. Nine of the ten major complications and all four of the failed osteotomies occurred in the first thirty hips in which the index procedure was performed. CONCLUSIONS: In our experience, the early results of the Bernese periacetabular osteotomy have been encouraging, with a 92% survival rate at thirty-six months. The occurrence of complications demonstrates a substantial learning curve. Recognition of the true preoperative acetabular version and reorientation of the acetabulum into an appropriately anteverted position have become important factors in surgical decision-making. LEVEL OF EVIDENCE: Therapeutic Level IV.     

Does Surgical Hip Dislocation and Periacetabular Osteotomy Improve Pain in Patients With Perthes-like Deformities and Acetabular Dysplasia?

BackgroundPatients with symptomatic residual Perthes-like deformities may present with a combination of structural abnormalities including a large aspheric femoral head, short and wide femoral neck, high greater trochanter, and acetabular dysplasia. Sometimes, the hip is further compromised by concurrent symptomatic femoroacetabular impingement (FAI) (proximal femoral deformities) and structural instability (acetabular dysplasia).Questions/purposesWe therefore sought to characterize (1) the intraoperative findings; (2) radiographic correction; and (3) early patient-reported outcomes, complications, and failures of treating complex Perthes-like hip deformities with combined surgical dislocation and periacetabular osteotomy (PAO).MethodsWe performed 694 hip preservation procedures between November 2006 and August 2010. Of these, 46 had residual Perthes-like hip deformities, defined as proximal deformity consistent with residual Perthes and a history of Perthes disease or treatment of pediatric hip dysplasia. Of these, we report on 16 patients (16 hips) with residual Perthes-like hip deformities and associated acetabular dysplasia (structural instability, defined as radiographic evidence of acetabular dysplasia with intraoperative confirmation of instability). These 16 patients were treated with a combined surgical hip dislocation to comprehensively address intraarticular and extraarticular sources of FAI and PAO to address structural instability and were analyzed at a minimum 24-month followup (median, 40 months; range, 24–78 months). No patients in this series were lost to followup. Ten patients’ hips had previous surgical treatment, including six with previous osteotomy. Operative findings were extracted from standardized prospectively collected intraoperative data collection forms. Radiographic correction was evaluated with established methods (lateral center-edge angle, anterior center-edge angle, acetabular inclination, center-to-trochanter distance) and clinical outcomes were measured with the modified Harris hip score (mHHS) as well as by prospectively recorded data on patient complications and followup.ResultsAcetabular labrochondral abnormalities included labral hypertrophy in all hips and labral and/or articular cartilage lesions requiring treatment in 13 hips. Radiographic analysis demonstrated consistent radiographic correction. The median preoperative mHHS improved from 64 to 92 at a median followup of 40 months (p < 0.001). Fourteen patients (14 hips) had a good or excellent clinical result. Two patients (two hips) were classified as failures based on mHHS less than 70 (n = 1) or conversion to total hip arthroplasty (n = 1).ConclusionsCombined surgical hip dislocation and PAO provides major deformity correction in Perthes-like hip deformities with associated acetabular dysplasia. Early clinical results suggest this technique is safe and effective. Long-term studies are needed to determine if improved long-term outcomes are associated with comprehensive deformity correction.

Level of Evidence

Level IV, therapeutic study.     

Periacetabular osteotomy through a modified ollier transtrochanteric approach for treatment of painful dysplastic hips

BACKGROUND: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results. METHODS: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 +/- 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint. RESULTS: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 +/- 15.8 points preoperatively to 87.97 +/- 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0 degrees +/- 12.9 degrees to 36.1 degrees +/- 12.3 degrees, the mean lateral center-edge angle had increased from -2.7 degrees +/- 14.4 degrees to 26.6 degrees +/- 14.1 degrees, the mean acetabular index angle had improved from 23.4 degrees +/- 6.6 degrees to 12.7 degrees +/- 4.6 degrees, and the mean acetabular head index had increased from 48.2% +/- 12.7% to 73.1% +/- 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each). CONCLUSIONS: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.     

髋臼周围截骨治疗成人髋关节发育不良

目的 探讨髋臼周围截骨治疗成人髋关节发育不良的手术适应证及疗效.方法 25例成人髋关节发育不良患者接受经改良Smith-Peterson人路的髋臼周围截骨术,女19例,男6例;年龄18～45岁,平均25.5岁.均为单侧发病,左侧14例,右侧11例.3例有既往手术史,2例Chari截骨术、1例Salter截骨术.髋关节骨关节炎T(o)nnis 0期13例、Ⅰ期9例、Ⅱ期3例.Shenton线不连续18例.髋臼外侧CE角4.57°±7.39°,前侧CE角0.95°±6.02°,髋臼顶倾斜角32.50°±5.96°,股骨头超出指数38.11%±5.70%,Harris髋关节评分(75.32±7.51)分.结果 全部患者随访2.0～7.5年,平均4.5年.3例髋关节骨关节炎T(o)nnis Ⅰ期者改善为0期,2例T(o)nnisⅡ期者改善为Ⅰ期,1例T(o)nnis Ⅰ期者进展为Ⅱ期.Shenton线不连续减少为10例.外侧CE角29.07°±5.81°,前侧CE角29.52°±4.51°,髋臼顶倾斜角19.17°±4.95°,股骨头超出指数24.20%±4.83%,Harris髋关节评分(84.88±4.88)分,与术前比较差异均有统计学意义.16例出现股外侧皮神经支配区感觉麻木,其中9例自行恢复,7例残留永久性麻木.1例出现髋关节周围Brooker Ⅰ型异位骨化.结论 经改良Smith-Peterson人路行髋臼周围截骨治疗成人髋关节发育不良可有效增加髋臼包容,改善关节功能,阻止髋臼周围硬化和囊性变,保持关节间隙,延缓骨关节炎进展.     

经髂腹股沟入路髋臼周围截骨治疗中年髋关节发育不良

 目的 探讨经髂腹股沟入路髋臼周围截骨治疗中年髋关节发育不良的手术适应证及疗效。方法 回顾性分析2005年8月至2010年2月采用经髂腹股沟入路髋臼周围截骨术治疗10例髋关节发育不良患者资料,男3例,女7例;年龄40～47岁,平均42岁;3例为双侧(单侧手术)、7例为单侧髋关节发育不良;左侧4例,右侧6例。2例有既往手术史,其中1例行Chari截骨术,1例行髋臼造盖术。髋关节骨关节炎分期：T?nnis 0期3例,Ⅰ期5例,Ⅱ期2例。6例Shenton线不连续。髋臼外侧CE角3.50°±4.88°,前侧CE角1.80°±5.07°,髋臼顶倾斜角18.20°±3.01°,股骨头超出指数31.30%±4.37%,Harris髋关节评分(67.40±7.75)分。结果 10例患者均获得随访,随访时间10～76个月,平均37个月。1例术前T?nnis Ⅰ期者术后改善为0期,1例Ⅱ期者改善为Ⅰ期,其余分期无变化。术后2例Shenton线不连续。末次随访外侧CE角30.40°±3.31°,前侧CE角29.50°±3.03°,髋臼顶倾斜角4.50°±2.55°,股骨头超出指数9.90%±4.33%,Harris髋关节评分(84.10±4.07)分。3例出现股外侧皮神经支配区感觉麻木,4～6个月自行恢复。1例出现髂窝血肿,2周后吸收消失,无残留症状。结论 只要严格掌握手术适应证,术中精细操作,经髂腹股沟入路髋臼周围截骨可治疗中年髋关节发育不良。     

伯尔尼髋臼周围截骨术对严重髋臼发育不良的治疗

目的 研究和分析使用伯尔尼髋臼周围截骨术治疗严重髋臼发育不良的中期临床和影像学结果.方法 1997年10月至2002年12月对18例(20髋)严重髋臼发育不良(Severin分级Ⅳb级)的患者接受了伯尔尼髋臼周围截骨术.患者手术时平均年龄21岁,平均随访时间6.2年.本组患者术前患髋均已出现疼痛,术前功能位片显示关节面吻合.术后影像学评价畸形的矫正范围,截骨处的愈合情况及关节炎的进展.临床结果和髋关节功能由Harris评分进行评价,术前Harris评分平均78.5分.结果 比较术前和术后X线片,外侧中心边缘角(CE角)、前方CE角和臼顶倾斜角均有显著改善.所有髂骨截骨均愈合.患者术后末次随访Harris评分平均91.1分.18例患者中的14例对手术效果表示满意.20髋中16髋临床结果优.但有5髋存在畸形矫正不足.结论 伯尔尼髋臼周围截骨术是治疗严重髋臼发育不良的有效术式.这一截骨术可以在各个平面对严重的骨缺损进行矫正,中期临床结果令人满意.     

Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy

BACKGROUND: This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy. METHODS: The diagnosis of femoro-acetabular impingement was based on clinical symptoms, a positive anterior impingement test, and findings of acetabular rim lesions on magnetic resonance imaging. The radiographic diagnosis of acetabular retroversion was based on the cross-over and posterior wall signs. Twenty-nine hips in twenty-two patients (average age, twenty-three years) underwent a periacetabular osteotomy. An arthrotomy was performed in twenty-six hips in order to visualize intra-articular lesions and, in selected cases, to improve a low femoral head-neck offset. The range of motion of the hip was measured, clinical evaluation was performed with use of the score described by Merle d'Aubigné and Postel, and the anterior center-edge angle of Lequesne and de Sèze was measured on radiographs preoperatively and at the time of the latest follow-up. RESULTS: The duration of follow-up averaged thirty months (range, twenty-four to forty-nine months). The anterior center-edge angle of Lequesne and de Sèze decreased significantly from a preoperative average of 36 degrees (range, 26 degrees to 52 degrees ) to a postoperative average of 28 degrees (range, 16 degrees to 46 degrees ) (p = 0.002). There was a significant increase in the average range of internal rotation (10 degrees, p = 0.006), flexion (7 degrees, p = 0.014), and adduction (8 degrees, p = 0.017). The average Merle d'Aubigné score increased from 14.0 points (range, 12 to 16 points) preoperatively to 16.9 points (range, 15 to 18 points) postoperatively (p < 0.001), and the result was good or excellent for twenty-six hips. Three hips underwent subsequent surgery: one, because of early postoperative loss of reduction; one, for correction of posteroinferior impingement; and one, because of recurrent signs of anterior impingement. CONCLUSION: Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion     

The periacetabular osteotomy. Minimum 2 year followup in more than 100 hips.

The results of 123 periacetabular osteotomies in 115 patients were reviewed at an average clinical followup of 4.3 years. The average age of the patients at the time of the operation was 32.9 years. The preoperative diagnosis was congenital dysplasia in 101 hips, Legg-Calve-Perthes disease in 10 hips, Charcot Marie Tooth disease in four hips, epiphyseal dysplasia in three hips, congenital coxa vara in two hips, slipped capital femoral epiphysis in one hip, and posttraumatic and postinfectious dysplasia in one hip each. The ilioinguinal approach was used in 67 hips and the modified Smith-Petersen approach was used in 56 hips. A periacetabular osteotomy was combined with an intertrochanteric osteotomy and/or trochanteric transfer in 32 hips. Ten hips underwent open reduction and internal fixation of an acetabular rim fracture and 18 arthrotomies were performed at the time of periacetabular osteotomy. The average Harris hip score increased from 65 points preoperatively to 89 points at latest followup. The average Merle d'Aubigne score increased from 13.6 points preoperatively to 16.3 points at latest followup. Overall, 83% of the hips were rated clinically as good to excellent. Seven hips have undergone total hip arthroplasty and six subsequent intertrochanteric osteotomies were performed. The majority of the major complications occurred when the osteotomy was performed through the ilioinguinal approach. The latest followup radiographic severity of osteoarthrosis, according to the criteria of T?nnis, improved or was unchanged in 117 hips (95%), and progressed in only six hips (5%). The majority of the hips with preoperative changes in the periarticular bone showed some evidence of regeneration, which was shown by a decrease in the subchondral sclerosis, disappearance of cysts, or healing of an acetabular rim fracture. The short term results of the periacetabular osteotomy are encouraging from the standpoint of improvements in clinical scores and in the appearance of the joint.     

Periacetabular osteotomy in the treatment of neurogenic acetabular dysplasia

We carried out the Bernese periacetabular osteotomy for the treatment of 13 dysplastic hips in 11 skeletally mature patients with an underlying neurological diagnosis. Seven hips had flaccid paralysis and six were spastic. The mean age at the time of surgery was 23 years and the mean length of follow-up was 6.4 years. Preoperatively, 11 hips had pain and two had progressive subluxation. Before operation the mean T?nnis angle was 33 degrees, the mean centre-edge angle was -10 degrees, and the mean extrusion index was 53%. Postoperatively, they were 8 degrees, 25 degrees and 15%, respectively. Pain was eliminated in 7 patients and reduced in four in those who had preoperative pain. One patient developed pain secondary to anterior impingement from excessive retroversion of the acetabulum. Four required a varus proximal femoral osteotomy at the time of the pelvic procedure and one a late varus proximal femoral osteotomy for progressive subluxation. Before operation no patient had arthritis. At the most recent follow-up one had early arthritis of the hip (T?nnis grade I) and one had advanced arthritis (T?nnis grade III). Our results suggest that the Bernese periacetabular osteotomy can be used successfully to treat neurogenic acetabular dysplasia in skeletally mature patients.     

Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty

It is not known if a previous periacetabular osteotomy poses technical difficulties and may increase the incidence of complications after total hip arthroplasty. The records of 41 patients who had THA after periacetabular osteotomy were evaluated. Followup averaged 6.9 years (range, 2-14 years). The average interval from osteotomy to total hip arthroplasty was 6.3 years (range, 4 months-14 years). Total hip arthroplasty provided significant relief of pain and improvement in function for all the patients. The acetabulum was judged to be retroverted in 23 patients and special attention to component positioning was needed. An abnormal proximal femoral anatomy secondary to previous intertrochanteric osteotomy or underlying dysplasia, or trochanteric overgrowth necessitated the use of trochanteric osteotomy for exposure in 24 patients. There were an acceptable number of complications and two revisions in the series. Aseptic loosening of the femoral component in one patient (one hip) and acetabular component in another patient (one hip) were the reasons for the two revisions. Total hip arthroplasty with technical consideration and careful evaluation of the acetabular version and relocated teardrop can be done safely in patients with a previous periacetabular osteotomy and should provide excellent results.     

Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities

Background  

Residual acetabular dysplasia of the hip in most patients can be corrected by periacetabular osteotomy. However, some patients have intraarticular abnormalities causing insufficient coverage, containment or congruency after periacetabular osteotomy, or extraarticular abnormalities that limit either acetabular correction or hip motion. For these patients, we believe an additional proximal femoral osteotomy can improve coverage, containment, congruency and/or motion.     

Results of periacetabular osteotomy in patients with previous surgery for hip dysplasia.

The results of 19 periacetabular osteotomies in 18 patients who had undergone prior bony surgical procedures for hip dysplasia were evaluated. There were 10 females and eight males with an average age of 30.9 years. Previous surgical interventions included 18 intertrochanteric osteotomies, nine pelvic osteotomies, and two shelf acetabuloplasties. The average clinical followup for this group was 45 months. Harris hip score averages improved from 60 to 90 points. Merle d'Aubigne scores showed similar elevations from 13.1 to 16.4 points. Radiographic assessment documented increased coverage and lower T?nnis secondary arthrosis grades in a significant number of hips. No significant differences in outcome were found between this group and a reference group of patients undergoing periacetabular osteotomy who had no previous hip surgery. These intermediate term results are encouraging and seem to discount anticipated problems of prior scarring and distorted pelvic and proximal femoral anatomy.     

Stoppa入路在髋关节发育不良髋臼周围截骨术中的应用

 目的 探讨Stoppa入路联合髂嵴切口应用于髋关节发育不良髋臼周围截骨术的安全性及有效性。方法2011年9月至2012年7月接受髋臼周围截骨术中应用Stoppa入路的髋关节发育不良患者18例20髋,女15例17髋,男3例3髋。患者年龄19~35岁,平均29岁。手术切口采用腹部横切口（即Stoppa入路）联合髂嵴切口（髂腹股沟入路的外侧窗）。记录手术时间、切口长度、术中出血量和异体血输血量,术后12个月门诊随访时评估髋关节功能、影像学征象和手术相关并发症。结果 手术时间125~180 min,平均145 min。Stoppa入路腹部横切口长5~10 cm,平均7 cm;髂嵴切口长4~8 cm,平均6 cm;切口总长度为12~16 cm,平均13 cm。术中出血量为500~1 600 ml,平均800 ml;异体血输血量为400~2 400 ml,平均1 161 ml。术后随访14~22个月,平均19.6个月。Harris髋关节评分由术前（80.3±8.5）分改善至术后12个月时（93.5±5.2）分,平均改善（13.2±6.0）分;中心边缘角由术前7.5°±5.4°改善至30.0°±4.6°,平均改善22.5°±4.5°。手术前后Harris髋关节评分与中心边缘角的差异均有统计学意义。全部截骨均愈合,愈合时间3~6个月,平均3.3个月。2髋耻骨支截骨延迟至术后6个月愈合。3例术后出现一过性股外侧皮神经麻痹,未予特殊处理。结论 Stoppa入路联合髂嵴切口能够安全有效地完成髋臼周围截骨术,可以代替传统的髂腹股沟入路用于无须髋关节探查的轻度髋关节发育不良患者。     

Cementless femoral reconstruction in patients with proximal femoral deformity

Distorted proximal femoral anatomy can pose a great technical challenge during total hip arthroplasty. Fifty-eight total hip arthroplasty were performed in 51 patients with proximal femoral deformity from 1998 to 2006. All hips except 2 were treated with cementless prosthesis. Twenty-three patients had a retained hardware that had to be removed. Nonprimary cementless components were used in 22 (25%) femurs. In 21 (23%) hips, osteotomy was required to properly fit the cementless stem in the femur. At the time of latest follow-up (4 years on average), functional scores showed significant improvement. Radiographically, all femoral components showed stable bone ingrowth except 2 hips (3.5%) with stable fibrous ingrowth and 1 hip (2%) with loosening. There were 2 (3.5%) revisions in 2 patients for periprosthetic fracture and femoral loosening. The mechanical failure rate was 9% (5 hips). Despite technical difficulties, cementless femoral reconstruction provides a reliable and durable result in patients with proximal femoral deformity.     

Long-Term Results of Periacetabular Rotational Osteotomy Concomitantly With Arthroscopy in Adult Acetabular Dysplasia

BackgroundAlthough the long-term results of periacetabular osteotomy in acetabular dysplasia have been well documented, there is paucity in reports on the long-term outcomes of periacetabular osteotomy with simultaneous hip arthroscopy. This study aimed to assess the cumulative 10-year outcomes of periacetabular rotational osteotomy with concomitant hip arthroscopy.MethodsThrough an arthroscopic procedure, the status of the labrum was assessed, and torn labrum was debrided. Evaluations on survival from conversion to total hip arthroplasty and success in radiographic and clinical long-term results were completed in 39 hips (36 patients). Acetabular parameters (center-edge angle, Sharp angle, acetabular-head index, and head lateralization index), Tönnis grades on radiograph, Harris Hip Score, and range of motion of the hip were evaluated. Survivorship analyses were evaluated with the Kaplan-Meier method.ResultsThirty-eight hips (97.4%, 95% confidence interval 0.832-0.996) were preserved for 12.8 ± 1.7 years on average, and only 1 hip was converted to total hip arthroplasty at 7.8 years. All the acetabular parameters were improved (P < .001). Twenty-eight hips (71.8%) showed unchanged or improved Tönnis grades at the latest follow-up. The average Harris Hip Score was significantly better than the preoperative value (P < .001), and range of motion was not significantly different until the latest follow-up.ConclusionSufficient acetabular reorientation, such as periacetabular rotational osteotomy, with concomitant arthroscopic debridement showed successful long-term outcomes for acetabular dysplasia in adults.     

Surgical treatment of developmental dysplasia of the hip in adults: I. Nonarthroplasty options

Hip dysplasia is a developmental disorder that results in anatomic abnormalities leading to increased contact pressure in the joint and, eventually, coxarthrosis. However, many patients with hip dysplasia become symptomatic before the development of severe degenerative changes because of abnormal hip biomechanics, mild hip instability, impingement, or associated labral pathology. Several nonarthroplasty treatment options are available. Because the primary deformity is mostly acetabular, for many patients, a reconstructive osteotomy that restores more nearly normal pelvic anatomy is preferable. The Bernese periacetabular osteotomy is presently favored because it provides good correction while creating little secondary pelvic deformity or destabilizing the pelvis. Proximal femoral osteotomy is occasionally needed as a complement to pelvic osteotomy and may also be indicated as an isolated procedure when most deformity is located on the femoral side (coxa valga subluxans). Arthroscopy can be beneficial when symptoms seem to be related only to labral tears or loose bodies in the absence of severe structural abnormalities about the hip. Fusion and resection arthroplasty are rarely indicated and are reserved for occasional patients who are not candidates for total hip replacement or other procedures but who complain of refractory hip pain.