scholarly journals Pelvic osteotomies for acetabular dysplasia: Are there outcomes, survivorship and complication differences between different osteotomy techniques?

2021 ◽  
Author(s):  
Edward C Beck ◽  
Anirudh K Gowd ◽  
Katlynn Paul ◽  
Jorge Chahla ◽  
Alejandro J Marquez-Lara ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Pelvic Osteotomy ◽  
Harris Hip Score ◽  
Rotational Acetabular Osteotomy ◽  
Complication Rates ◽  
Radiographic Measurements ◽  
Wide Range ◽  
Patient Reported ◽  
Pao Surgery

Abstract The purpose of this study was to evaluate the safety and efficacy of Periacetabular osteotomy (PAO), rotational acetabular osteotomy (RAO), and eccentric rotational acetabular osteotomy (ERAO) for treating hip dysplasia by comparing complication rates, survivorship, and functional outcomes after treatment. A systematic review in the MEDLINE and CINAHL databases was performed, and studies reporting outcomes after pelvic osteotomy for hip dysplasia with a minimum of 1-year follow-up or reported postoperative complications was included. Patient demographics, radiographic measurements, patient reported outcomes including the modified Harris hip score (mHHS), complications using the modified Clavien-Dindo classification, and reoperations were extracted from each study. A meta-analysis of outcome scores, complications, change in acetabular coverage, and revision rates for the 3 pelvic osteotomies was performed. A total of 47 articles detailing outcomes of 6,107 patients undergoing pelvic osteotomies were included in the final analysis. When stratified by procedure, RAO had a statistically greater change in LCEA when compared to PAO (33.9° vs 18.0°; P <0.001). The average pooled mHHS improvement was 15.6 (95% CI: 8.3–22.8, I2= 99.4%). Although ERAO had higher mean score improvements when compared to RAO and PAO, the difference was not statistically significant (P >0.05). Lastly, patients undergoing PAO had a statistically greater complication rate than those undergoing ERAO and RAO (P <0.001 for both), while revision rate was not statistically different between the 3 techniques. In summary, there are many more publications on PAO surgery with a wide range of reported complications. Complications after ERAO and RAO surgery are lower than PAO surgery in the literature, but it is unclear whether this represents an actual difference or a reporting bias. Lastly, there are no significant differences between revisions, or postoperative reported outcomes between the 3 techniques.

scholarly journals Successful Outcomes at Midterm Follow-up of Periacetabular Osteotomy Done for Mild Hip Dysplasia

2017 ◽  
Vol 01 (04) ◽  
pp. 167-172 ◽  
Author(s):  
G. Potter ◽  
Eduardo Novais ◽  
Robert Trousdale ◽  
Rafael Sierra
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Demographic Variables ◽  
Harris Hip Score ◽  
Control Group ◽  
Center Edge ◽  
Radiographic Measurements ◽  
Significant Difference

AbstractYoung hip surgeons are often faced with the decision to either perform arthroscopic surgery or a periacetabular osteotomy (PAO) in patients with symptomatic mild hip dysplasia (MHD). There is, however, a paucity of data on the results of PAO in this group. The aim of this paper is to report the results of PAOs in patients with MHD and compare those to hips with more severe forms of hip dysplasia (SHD). This data can then be used to compare emerging data reporting the results of hip arthroscopy for MHD. From January, 1996 to May, 2009, 299 hips in 268 patients were identified that underwent PAO at one institution. After removing those with <2 years of follow-up, 182 hips were followed up. The average age of the cohort was 31 years, and 85% were female. Nineteen hips with lateral center edge (LCE) angle from 18 to 25° and a Tönnis angle (TA) between 10 and 15° were considered to have MHD. This group was compared with the rest of the cohort (SHD). The mean clinical follow-up for the MHD group was 121 months. There was no significant difference in demographic variables between the groups. There were no complications in the MHD cohort. Surgical correction resulted in significant improvements in all radiographic measurements consistent with hip dysplasia in both groups. The Harris Hip Score (HHS) improved significantly in both groups ([MHD: 52–92] [SHD: 66–89]). Two hips (10.5%) in the MHD group and 15 hips (9.2%) in the SHD group underwent future THA (p = 0.69). The survivorship free from THA was 100%, 100%, and 86% at 3, 5, and 10 years, respectively, in the MHD group. The corresponding rates for hips in the control group at 3, 5, and 10 years, respectively, were 99%, 95%, and 81%. PAO in patients with MHD provides predictable improvements in pain, function, and results that are durable and comparable to hips with SHD. This data should be used to compare the early and midterm results of arthroscopic surgery performed in mildly dysplastic hips.

scholarly journals Validity of PROMIS physical function in patients with hip dysplasia treated with periacetabular osteotomy

2019 ◽  
Author(s):  
Malynda Wynn ◽  
Alan Shamrock ◽  
Zain Khazi ◽  
Robert Westermann ◽  
Michael Willey
Keyword(s):  
Young Adults ◽  
Physical Function ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Hip Osteoarthritis ◽  
Correlation Coefficients ◽  
Harris Hip Score ◽  
Measurement Information ◽  
Patient Reported ◽  
Pro Instruments

Abstract Hip dysplasia is known to lead to pain, disability, depression and eventually secondary hip osteoarthritis in young adults. Performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) Computer Adaptive Test (CAT) in hip dysplasia patients indicated for periacetabular osteotomy (PAO) is unknown. The aim of this investigation was to validate the use of PROMIS PF CAT with currently accepted patient-reported outcome (PRO) instruments in young adults with hip dysplasia indicated for PAO. Individuals indicated for PAO to treat symptomatic hip dysplasia were identified and consented to complete the PROMIS PF CAT, Hip disability and Osteoarthritis Outcome Score Physical Function Shortform (HOOS-PS), modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) questionnaires during their pre-operative visit to test correlations between instruments as part of the validation of PROMIS PF CAT. The relationship between PRO instruments was compared using Spearman correlation coefficients. Correlation between PRO instruments were defined as high (>0.7), high-moderate (0.61–0.69), moderate (0.4–0.6), moderate-weak (0.31–0.39) and weak (≤0.3). Forty-one individuals to undergo PAO were enrolled. The PROMIS PF CAT correlated moderate to high and demonstrated construct validity with traditionally used hip PRO instruments. Additionally, the question burden was decreased with no floor or ceiling effects observed. In conclusion, PROMIS PF CAT is an efficient and valid tool for pre-operative clinical assessment of pain and disability hip dysplasia patients undergoing PAO.

scholarly journals Return to Sport Rates and Functional Outcomes Following Bilateral Hip Arthroscopy in High-Level Athletes

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Benjamin Domb ◽  
Cynthia Kyin ◽  
Jacob Shapira ◽  
David Maldonado ◽  
Ajay Lall ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Professional Athlete ◽  
Patient Reported ◽  
High Level ◽  
Modified Harris Hip Score

Objectives: To determine the rate of return to sport (RTS) in high-level athletes undergoing bilateral hip arthroscopy and report minimum 1-year patient-reported outcomes (PROs) for this cohort. We hypothesized that RTS rates, as well as sport-specific PROs, will be lower than the rates and scores previously reported in the literature for unilateral hip arthroscopy. Methods: Data were prospectively collected on all patients undergoing hip arthroscopy at our institution from November 2011 to July 2018. Patients were included if they underwent bilateral hip arthroscopy and were either a high school, collegiate, or professional athlete prior to their first surgery. RTS was defined as a patient’s return to competitive participation in their respective sport. Additional PROs, including modified Harris Hip Score (mHHS), nonarthritic hip score (NAHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS), as well as complication rates and future surgeries were documented and compared for all patients. Results: A total of 87 patients met inclusion criteria, for which follow-up was available for 82 (94.3%). At latest follow-up, 44 (53.7%) patients returned to sport. Of patients returning, 56% did so at the same level or higher. The most common reasons for not returning to sport were due to graduation/lifestyle change (47.4%) and hip symptoms (44.7%). Patients returning to sport had significantly higher PROs at latest follow-up relative to those who did not return, including for mHHS (93.7 vs. 87.5), NAHS (94.4 vs. 88.2), HOS-SSS (90.9 vs. 78.2) (P < 0.05). Rates of achieving PASS and MCID for mHHS were not significantly different. However, for HOS-SSS, patients who returned had significantly higher rates of achieving the MCID and PASS. Conclusion: Rates of RTS after bilateral hip arthroscopy are lower than those after unilateral hip arthroscopy. When comparing patients that returned to sports and those who did not return, we show that although both groups show a significant improvement in PROs following surgery, those that returned to sport achieved significantly higher scores in all outcome measures. In addition, patients returning to sports showed a significantly higher rate of attaining MCID and PASS scores for the HOS-SSS, possibly attesting to the validity of this score and its thresholds.

Need for standard outcome reporting systems in craniosynostosis

2011 ◽  
Vol 31 (2) ◽  
pp. E1 ◽  
Author(s):  
Caroline Szpalski ◽  
Katie Weichman ◽  
Fabio Sagebin ◽  
Stephen M. Warren
Keyword(s):  
Health Care Professionals ◽  
Treatment Options ◽  
Case Series ◽  
Functional Results ◽  
Series Data ◽  
Quality Level ◽  
Complication Rates ◽  
Outcome Reporting ◽  
Radiographic Measurements ◽  
Patient Reported

Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no parameters or guidelines of care. Establishing such parameters was an important step forward in the treatment of patients with craniosynostosis, but results are still assessed using radiographic measurements, complication rates, and ad hoc reporting scales. Therefore, clinical outcome reporting in the treatment of craniosynostosis is inconsistent and lacks methodological rigor. Today, most reported evidence in the treatment of craniosynostosis is level 5 (expert opinion) or level 4 (case series) data. Challenges in obtaining higher quality level 1 or level 2 data include randomizing patients in a clinical trial as well as selecting the appropriate outcome measure for the trial. Therefore, determining core outcome sets that are important to both patients and health care professionals is an essential step in the evolution of caring for patients with craniosynostosis. Traditional clinical outcomes will remain important, but patient-reported outcomes, such as satisfaction, body image, functional results, and aesthetic outcomes, must also be incorporated if the selected outcomes are to be valuable to patients and families making decisions about treatment. In this article, the authors review the most commonly used tools to assess craniosynostosis outcomes and propose a list of longitudinal parameters of care that should be considered in the evaluation, diagnosis, and treatment evaluation of a patient with craniosynostosis.

Complications and Short-Term Patient Outcomes of Periacetabular Osteotomy for Symptomatic Mild Hip Dysplasia

2016 ◽  
Vol 27 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Benjamin F. Ricciardi ◽  
Kara G. Fields ◽  
Catherine Wentzel ◽  
Danyal H. Nawabi ◽  
Bryan T. Kelly ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Harris Hip Score ◽  
Severe Dysplasia ◽  
Complication Rates ◽  
Radiographic Findings ◽  
Mild Dysplasia ◽  
Early Functional Outcome ◽  
Outcome Scores

Introduction The purpose of our study is to identify complications and early functional outcome scores in patients treated with periacetabular osteotomy (PAO) for mild acetabular dysplasia. Methods The study population consisted of patients from a single centre prospective hip registry undergoing PAO with mild acetabular dysplasia (LCEA ≥18° and ≤25°; n = 27 patients; Mild Dysplasia group). A comparison group of patients undergoing PAO with more severe acetabular dysplasia (lateral centre-edge angle [LCEA] ≤17°; n = 50 patients; Severe Dysplasia group) were included as a comparison cohort. Demographics, radiographic findings, complications, and functional outcome scores were recorded at 6 months, 1 year, and 2 years postoperatively (mean 15 months [range 6-30]). Results Demographic characteristics were similar in patients with mild dysplasia undergoing PAO compared with more severe dysplasia. Achievement of radiological correction and complication rates were not different between the 2 groups. Functional outcome scores showed similar improvements in modified Harris Hip Score (mHHS), hip outcome score (HOS) activities of daily living (ADL), HOS Sport, and the international Hip Outcome Tool-33 (iHOT-33) at all time points between the 2 groups with over 90% of patients in the mild dysplasia group achieving a minimum important change (MIC) in functional outcome scores at final follow-up. Discussion Patients with symptomatic mild acetabular dysplasia undergoing PAO have similar complication rates and functional outcomes as a cohort of patients with more severe dysplasia.

scholarly journals Development of the HOOSglobal to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures

2018 ◽  
Vol 46 (4) ◽  
pp. 940-946 ◽  
Author(s):  
Cale A. Jacobs ◽  
Michael R. Peabody ◽  
Stephen T. Duncan ◽  
Ryan D. Muchow ◽  
Ryan M. Nunley ◽  
...  
Keyword(s):  
Los Angeles ◽  
Short Form ◽  
Periacetabular Osteotomy ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Orthopaedic Community ◽  
Pro Tools ◽  
Modified Harris Hip Score

Background: The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations. Hypothesis: The HOOS, JR would demonstrate a notable ceiling effect, but by augmenting the HOOS, JR with additional HOOS questions, a responsive PRO platform could be created. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Using preoperative and postoperative HOOS responses from a sample of 304 patients undergoing periacetabular osteotomy (PAO), additional items were identified to augment the HOOS, JR. The psychometric properties of a newly created PRO tool (HOOSglobal) were then compared with the HOOS, JR and other PRO instruments developed for patients with hip OA and/or undergoing THA. Results: By augmenting the HOOS, JR with 2 additional questions, the HOOSglobal was more responsive than all other included PRO tools and had significantly fewer maximum postoperative scores than the HOOS, JR ( P < .0001), HOOS–Physical Function Short form ( P < .0001), Western Ontario and McMaster Universities Osteoarthritis Index ( P = .02), University of California, Los Angeles activity scale ( P = .0002), and modified Harris Hip Score ( P = .04). The postoperative HOOSglobal score threshold associated with patients achieving the patient acceptable symptom state (PASS) was 62.5. Conclusion: The HOOSglobal is a valid and responsive PRO tool after PAO and may potentially provide the orthopaedic community with a PRO platform to be used across hip-related subspecialties. For patients undergoing PAO, a postoperative HOOSglobal score ≥62.5 was associated with patients achieving the PASS.

scholarly journals Outcomes After Arthroscopic Management of Subspinous Impingement in Borderline Hip Dysplasia

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0011
Author(s):  
Daniel Feghhi ◽  
Srino Bharam ◽  
Jonathan Shearin
Keyword(s):  
Repeated Measures ◽  
Hip Dysplasia ◽  
Alpha Angle ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Arthroscopic Management ◽  
Hip Impingement ◽  
Patient Reported

Objectives: Arthroscopic management of femoroacetabular impingement in the setting of borderline hip dysplasia is controversial. There is concern for iatrogenic hip instability with rim-resection in an already structurally compromised acetabulum. Recently, there has been increased awareness of a prominent anterior inferior iliac spine (AIIS) resulting in subspinous impingement. The purpose of this study was to report on the outcomes of arthroscopic subspinous decompression in patients with symptomatic hip impingement and borderline hip dysplasia. Methods: An IRB approved retrospective study of patients with symptomatic hip impingement, borderline dysplasia (LCEA 18-24°) and prominent AIIS who failed conservative management and subsequently underwent arthroscopic subspinous decompression was conducted. Eighteen patients, 19 hips (4 male and 14 female, average age 28) were identified from 2012 to 2015. 3D-CT imaging was used to categorize AIIS morphology into Type 1, 2 or 3 (Hetsroni classification). Alpha angle and femoral version were determined as well. Patient-reported outcome scores (PROs) consisting of the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS) were obtained preoperatively and at an average of 44 months postoperative (range, 23-61 months). Results: There were no postoperative complications or symptoms of instability. Fourteen hips were of Type 2 AIIS morphology and 6 were categorized as type 1. Femoral osteoplasty was performed in 17 hips (average alpha angle 66°). Repeated measures ANOVA revealed a significant improvement in all PROs from preop to latest follow-up; (mHHS 64.7, 93.4, p< .001; HOS-ADL 62.1, 94.6, p< .001; HOS-SSS 26.5, 93.4 p< .001). An ANCOVA revealed patients with type 2 AIIS had a significantly higher post-op mHHS than those with a type 1 morphology; (88.3, 95.6, p< .01). Conclusion: Arthroscopic AIIS decompression in patients with co-existing borderline dysplasia and subspinous impingement leads to favorable outcomes without compromising hip stability.

Prospective Randomized Comparison of Capsular Management Techniques During Hip Arthroscopy

2019 ◽  
Vol 48 (2) ◽  
pp. 395-402 ◽  
Author(s):  
Kostas J. Economopoulos ◽  
Anikar Chhabra ◽  
Christopher Kweon
Keyword(s):  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Management Technique ◽  
Outcome Score ◽  
Radiographic Measurements ◽  
Patient Reported ◽  
Management Techniques

Background: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. Purpose/Hypothesis: The purpose was to perform a prospective randomized trial to comparatively assess 3 commonly performed capsular management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes when compared with unclosed capsulotomy management techniques. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients (N = 150) who had hip arthroscopy with labral repairs and femoral osteoplasties performed by the senior author were randomly assigned into 3 groups at the time of their surgery: T-capsulotomy without closure (TC), interportal capsulotomy without closure (IC), and interportal capsulotomy with closure (CC). All patients underwent labral repair and femoral osteoplasty. Patient-reported outcomes were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Other outcomes obtained included the need for future hip surgery. Results: Patient demographics, preoperative patient-reported outcomes, and radiographic measurements were similar among all 3 groups. Revision hip arthroscopy was performed in 5 TC cases, 2 IC cases, and 1 CC case ( P = .17). Conversion to hip arthroplasty occurred in 4 patients in the TC group and none in the IC and CC groups ( P = .02). The CC group showed higher modified Harris Hip Score (mHHS) and Hip Outcome Score–Activities of Daily Living (HOS-ADL) at the 2-year follow-up when compared with the IC group ( P = .003 and P < .001, respectively). When compared with the TC group, the CC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (Hip Outcome Score–Sports-Specific Subscale; 74.4 vs 65.3) at the final 2-year follow-up ( P < .001). At the 2-year follow-up, the IC group had a higher mHHS (81.7 vs 76), HOS-ADL (82 vs 76.8), and HOS-SSS (71.4 vs 65.3; P > .001) as compared with the TC group. Conclusion: Patients undergoing complete capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes when compared with those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsular management technique.

Patients With Borderline Hip Dysplasia Achieve Clinically Significant Outcome After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With Minimum 2-Year Follow-up

2019 ◽  
Vol 47 (11) ◽  
pp. 2636-2645 ◽  
Author(s):  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Jorge Chahla ◽  
Kyleen Jan ◽  
Timothy C. Keating ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Alpha Angle ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Acetabular Coverage ◽  
Patient Reported ◽  
Clinically Significant ◽  
Modified Harris Hip Score ◽  
Preoperative Predictors

Background: There is a growing trend for hip arthroscopists to treat patients with borderline hip dysplasia (BHD) for femoroacetabular impingement syndrome (FAIS) without addressing the acetabular coverage. However, the literature of outcomes and failure rates for these patients is conflicting. Purpose: (1) To identify whether patients with BHD achieved 2-year similar patient-reported outcome, minimal clinically important difference (MCID), and patient acceptable symptomatic state (PASS) when compared with patients without BHD and (2) to identify predictors for achieving the MCID and PASS among patients with BHD who are undergoing hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Data from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS between January 2012 and January 2017 were collected and retrospectively analyzed. Patients with BHD (lateral center-edge angle [LCEA], 20°-25°) were matched 2:1 by age, sex, and body mass index (BMI) to control patients with normal acetabular coverage (LCEA, >25°-40°). Patient-reported outcome, MCID, and PASS were compared between the groups. Multivariate logistic regression analysis identified significant predictors of achieving the MCID and PASS in the BHD group. Results: The MCID in the BHD group was defined as 9.2, 13.7, 8.5, and 15.2 for the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport Specific, modified Harris Hip Score, and iHOT-12, respectively. Threshold scores for achieving the PASS in both groups were 87.9, 76.4, 78.1, and 60.0. A total of 112 patients were identified as having BHD (LCEA, 20°-25°) and were matched to 224 controls. Both groups saw statistically significant increases in score averages over the 2-year period; however, the differences between them were not statistically significant ( P > .05 for all). There was no statistical difference in the frequency of the BHD and non-BHD cohorts achieving the MCID on at least 1 threshold score (86.6% vs 85.6%, P = .837) and the PASS (78.6% vs 79.8%, P = .79). There was, however, a statistically significant difference between the rates of patients with and without BHD achieving the PASS on the modified Harris Hip Score threshold (62.5% vs 74.5%, P = .028). The final logistic models demonstrated that lower BMI (odds ratio [OR], 0.872; P = .029), lower preoperative alpha angle (OR, 0.965; P = .014), and female sex (OR, 3.647; P = .03) are independent preoperative predictors of achieving the MCID, while lower preoperative alpha angle (OR, 0.943; P = .018) and self-reported limp (OR, 18.53; P = .007) are independent preoperative predictors of achieving the PASS. Conclusion: Outcome improvements in patients with BHD who are undergoing arthroscopic treatment with capsular closure for FAIS are not significantly different from patients with normal acetabular coverage. Lower BMI, lower alpha angle, absence of limp, and female sex are preoperative predictors of achieving meaningful clinically significant outcome improvements in patients with BHD.

scholarly journals Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

2017 ◽  
Vol 7 (1) ◽  
pp. 51-57
Author(s):  
Steven A Olson ◽  
Julie A Neumann ◽  
Kathleen D Rickert ◽  
Brian D Lewis ◽  
Kendall E Bradley ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Operative Time ◽  
Perioperative Complications ◽  
Periacetabular Osteotomy ◽  
Wound Complications ◽  
Complication Rates ◽  
Center Edge ◽  
Estimated Blood Loss ◽  
Articular Pathology

ABSTRACT Purpose To evaluate the safety of hip arthroscopy combined with a periacetabular osteotomy (PAO) compared with PAO alone in treating concomitant intra-articular pathology in hip dysplasia. Materials and methods Forty-one patients (46 hips) with symptomatic hip dysplasia were retrospectively reviewed. Pre- and postoperative radiographic data and intraoperative data consisting of estimated blood loss, intraoperative and postoperative blood transfusions, operative time, and length of hospital stay were recorded. The complications occurring within the first 3 months after surgery including lateral femoral cutaneous and pudendal nerve neuropraxia, wound complications, and reoperations were recorded. Additionally, rates of deep venous thrombosis and other major adverse outcomes (myocardial infarction, pulmonary embolism, stroke, death) were examined. Results Twenty-one patients (24 hips) underwent PAO alone. Twenty patients (22 hips) underwent hip arthroscopy followed immediately by PAO. There were no significant differences in the 90-day complication rates between the two groups, comparing the rate of neuropraxia (p = 0.155) and wound complications (p = 0.6). Operative time for PAO alone was 179 minutes (standard deviation [SD] ± 37) compared with 251 minutes (SD ± 52) for combined hip arthroscopy and PAO (p < 0.001). No incidence of deep vein thrombosis or major adverse events was noted in either group. Preoperative lateral center edge angle (LCEA) and acetabular index (AI) were 14° and 20° respectively, in the PAO-alone group and 19° and 16° respectively, in the combined group. Postoperatively, LCEA was 29° in the PAO-alone group and 30° in the combined group. Postoperative AI was 11° in the PAO-alone group and 5° in the combined group. Conclusion This study demonstrates that hip arthroscopy in combination with PAO to treat intra-articular pathology shows no difference in 90-day complication rates when compared with PAO alone. Level of evidence Level III, retrospective comparative study How to cite this article Neumann JA, Rickert KD, Bradley KE, Lewis BD, France MA, Olson SA. Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone? The Duke Orthop J 2017;7(1):51-57.

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