scholarly journals Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes

2021 ◽  
Author(s):  
Naif Z Alrashdi ◽  
Robert W Motl ◽  
Elroy J Aguiar ◽  
Michael K Ryan ◽  
Suzanne E Perumean-Chaney ◽  
...  
Keyword(s):  
Real World ◽  
Acetabular Dysplasia ◽  
Walking Speed ◽  
Periacetabular Osteotomy ◽  
Future Research ◽  
Patient Reported ◽  
Study Characteristics ◽  
Hip Function ◽  
Four Square ◽  
Symptomatic Acetabular Dysplasia

ABSTRACT Periacetabular osteotomy (PAO) is a surgery for persons with symptomatic acetabular dysplasia (AD) that increases acetabular coverage of the femoral head for reducing hip pain and improving function. Patient-reported outcomes (PROs) are significantly improved following PAO, yet little is known regarding mobility-related outcomes. This narrative review provides a synthesis of evidence regarding PROs and mobility-related outcomes in persons with AD following PAO. We further identified important future research directions, chiefly the need for measurement of real-world outcomes. We searched PubMed using comprehensive predefined search terms. We included studies that (i) enrolled persons with AD undergoing PAO, (ii) included PROs and/or mobility-related outcomes and (iii) were written in English. We synthesized and summarized study characteristics and findings. Twenty-three studies were included in this review. Commonly evaluated PROs included pain (n = 14), hip function (n = 19) and quality of life (n = 9). Mobility-related outcomes included self-reported physical activity (PA; n = 11), walking speed and cadence (n = 4), device-measured PA (n = 2), and sit-to-stand, four-square-step and timed stair ascent tests (n = 1). Persons with AD had significant improvements in PROs following PAO, yet mobility-related outcomes (e.g. walking speed and device-measured PA levels) did not change over 1 year following PAO. Few studies have evaluated mobility-related outcomes following PAO, and these studies were of a low methodological quality. Future research might include experience sampling data collection approaches and body-worn devices as free-living, technology-driven methodologies to evaluate mobility and other outcomes in persons with AD undergoing PAO.

scholarly journals Ottawa classification for symptomatic acetabular dysplasia assessment of interobserver and intraobserver reliability

2020 ◽  
Vol 9 (5) ◽  
pp. 242-249
Author(s):  
K. Bali ◽  
K. Smit ◽  
M. Ibrahim ◽  
S. Poitras ◽  
G. Wilkin ◽  
...  
Keyword(s):  
Classification System ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Consensus Meeting ◽  
Flow Diagram ◽  
Substantial Agreement ◽  
Perfect Agreement ◽  
Radiological Measurements ◽  
Symptomatic Acetabular Dysplasia ◽  
Overall Reliability

Aims The aim of the current study was to assess the reliability of the Ottawa classification for symptomatic acetabular dysplasia. Methods In all, 134 consecutive hips that underwent periacetabular osteotomy were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior, or posterior. A total of 74 cases were selected for reliability analysis, and these included 44 dysplastic and 30 normal hips. A group of six blinded fellowship-trained raters, provided with the classification system, looked at these radiographs at two separate timepoints to classify the hips using standard radiological measurements. Thereafter, a consensus meeting was held where a modified flow diagram was devised, before a third reading by four raters using a separate set of 74 radiographs took place. Results Intrarater results per surgeon between Time 1 and Time 2 showed substantial to almost perfect agreement among the raters (κappa = 0.416 to 0.873). With respect to inter-rater reliability, at Time 1 and Time 2 there was substantial agreement overall between all surgeons (Time 1 κappa = 0.619; Time 2 κappa = 0.623). Posterior and anterior rating categories had moderate and fair agreement at Time 1 (posterior κappa = 0.557; anterior κappa = 0.438) and Time 2 (posterior κappa = 0.506; anterior κappa = 0.250), respectively. At Time 3, overall reliability (κappa = 0.687) and posterior and anterior reliability (posterior κappa = 0.579; anterior κappa = 0.521) improved from Time 1 and Time 2. Conclusion The Ottawa classification system provides a reliable way to identify three categories of acetabular dysplasia that are well-aligned with surgical management. The term ‘borderline dysplasia’ should no longer be used. Cite this article: Bone Joint Res. 2020;9(5):242–249.

scholarly journals Does pain and hip function improve 2 years after reverse periacetabular osteotomy? A follow-up study of 74 patients

2020 ◽  
Vol 7 (1) ◽  
pp. 130-139 ◽  
Author(s):  
Christina Nielsen Bræmer ◽  
Sarah Ankjær Langberg ◽  
Stig Storgaard Jakobsen ◽  
Søren Reinhold Jakobsen ◽  
Hugo Aleixo ◽  
...  
Keyword(s):  
Short Form ◽  
Periacetabular Osteotomy ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
University Hospital ◽  
Follow Up Study ◽  
Background Population ◽  
Patient Reported ◽  
Hip Function

Abstract Data on outcome in patients with acetabular retroversion (AR) treated with reverse periacetabular osteotomy (reverse PAO) are sparse. The aim of the study was to investigate changes in pain and hip function among patients with AR 2 years after reverse PAO and to examine whether changes in pain were associated with changes in hip function. In addition, to evaluate patient satisfaction and changes in quality of life (QoL). We present a prospective follow-up study with patient-reported outcome data from Aarhus University Hospital in Denmark. Pain at rest and during activity was measured with a Visual Analogue Scale (VAS), hip function with the Hip disability and Osteoarthritis Outcome Score (HOOS) and QoL with the Short-Form 36, pre-operatively and 2 years after reverse PAO in 74 patients. Changes were analysed using paired t-test and multiple linear regressions. Significant and clinically relevant mean improvements in pain and hip function were found. The numbers of responders achieving a minimal clinically important difference varied from 51 to 73%. Positive significant association between changes in pain and changes in hip function were found. Significant mean improvement in QoL was found. The study had a loss to follow-up of 23%. Two years after reverse PAO, patients diagnosed with AR showed significant and clinically relevant mean improvements in pain and hip function. Decreased pain was significantly associated with improved hip function. The majority of patients were satisfied with the result of surgery and QoL was similar to the Danish background population.

Activity Level Maintenance at Midterm Follow-up Among Active Patients Undergoing Periacetabular Osteotomy

2019 ◽  
Vol 47 (14) ◽  
pp. 3455-3459
Author(s):  
Ugochi C. Okoroafor ◽  
Cecilia Pascual-Garrido ◽  
Maria T. Schwabe ◽  
Jeffrey J. Nepple ◽  
Perry L. Schoenecker ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Activity Levels ◽  
Center Edge ◽  
Ucla Score ◽  
The Mean ◽  
Symptomatic Acetabular Dysplasia ◽  
Active Patients ◽  
Center Edge Angle

Background: For active patients undergoing periacetabular osteotomy (PAO), returning to and maintaining a high level of activity postoperatively is a priority. Purpose: To evaluate the maintenance of activity levels at midterm follow-up in active patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent PAO for symptomatic acetabular dysplasia between June 2006 and August 2013 were identified by a retrospective review of our prospective longitudinal institutional Hip Preservation Database. All patients with a preoperative University of California, Los Angeles (UCLA) score of ≥7 and a potential minimum 5 years of follow-up were included in the study. Functional outcome measures were the UCLA score, modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The maintenance of high activity levels was defined as a UCLA score of ≥7 at final follow-up. Radiographic parameters were measured. Statistical significance was defined as a P value <.05. Results: A total of 66 hips (58 patients) were included. The mean age was 25.3 years (range, 14-47 years), the mean body mass index was 23.9 kg/m2 (range, 19-32 kg/m2), and 72% were female. The mean follow-up was 6.8 years (range, 5-11 years). There were 67% of patients who maintained a UCLA score of ≥7. Patient-reported outcomes improved postoperatively from preoperatively for the mHHS (88 ± 14 vs 67 ± 17, respectively; P < .001) and WOMAC (89 ± 15 vs 73 ± 20, respectively; P < .001). The lateral center-edge angle, anterior center-edge angle, and acetabular inclination were significantly improved at final follow-up ( P < .001). Only 4 patients (7%) cited postoperative activity limitations as being caused by hip pain. There were no conversions to total hip arthroplasty. Conclusion: The majority (67%) of active patients returned to preoperative or higher activity levels after PAO at midterm follow-up.

PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia

2020 ◽  
Vol 48 (2) ◽  
pp. 385-394 ◽  
Author(s):  
Deborah J. Li ◽  
John C. Clohisy ◽  
Maria T. Schwabe ◽  
Elizabeth L. Yanik ◽  
Cecilia Pascual-Garrido
Keyword(s):  
Outcome Measures ◽  
Acetabular Dysplasia ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Ceiling Effects ◽  
The Mean ◽  
Symptomatic Acetabular Dysplasia ◽  
Good Agreement

Background: No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). Purpose: To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. Results: The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain ( r = −0.66; P < .0001) and mHHS ( r = −0.60; P < .0001) preoperatively and the HOOS pain ( r = −0.64; P < .0001) and mHHS ( r = −0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL ( r = 0.51; P < .0001) and mHHS ( r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL ( r = 0.56; P < .0001) and mHHS ( r = 0.56; P < .0001). Conclusion: We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.

Analysis of Femoral Version in Patients Undergoing Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia

2018 ◽  
Vol 26 (15) ◽  
pp. 545-551 ◽  
Author(s):  
Wudbhav N. Sankar ◽  
Eduardo Novais ◽  
Denise Koueiter ◽  
Christian Refakis ◽  
Ernest Sink ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Femoral Version ◽  
Symptomatic Acetabular Dysplasia

Correlation of Patient-Reported Outcomes After Periacetabular Osteotomy With Femoral Head Coverage and Acetabular Orientation: A Single-Center Cohort Study

2021 ◽  
Vol 49 (5) ◽  
pp. 1209-1219
Author(s):  
Mazen M. Ibrahim ◽  
Kevin Smit ◽  
Stéphane Poitras ◽  
George Grammatopoulos ◽  
Paul E. Beaulé
Keyword(s):  
Cohort Study ◽  
Femoral Head ◽  
Daily Living ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Single Center ◽  
Femoral Head Coverage ◽  
3 Dimensional ◽  
Acetabular Orientation ◽  
Patient Reported

Background: Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO). Purpose: (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale. Results: At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage <75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index >15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification ( P < .001). Conclusion: Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.

scholarly journals BORDERLINE ACETABULAR DYSPLASIA: INDEPENDENT PREDICTORS OF HIP INSTABILITY VERSUS IMPINGEMENT

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0001
Author(s):  
Jeffrey J. Nepple ◽  
Elizabeth A. Graesser ◽  
Joel Wells ◽  
John Clohisy
Keyword(s):  
Range Of Motion ◽  
Clinical Characteristics ◽  
Acetabular Dysplasia ◽  
Alpha Angle ◽  
Hip Pain ◽  
Harris Hip Score ◽  
Hip Instability ◽  
Patient Reported ◽  
Symptomatic Acetabular Dysplasia ◽  
Lateral Hip Pain

Background: Hips with borderline acetabular dysplasia (lateral center-edge angle, LCEA, between 20° and 25°) are challenging in terms of diagnostic and treatment decision-making. It is accepted that a portion of this population has primarily hip instability-based symptoms consistent with symptomatic acetabular dysplasia, while others have primarily hip impingement-based symptoms consistent with femoroacetabular impingement (FAI). Nevertheless, the diagnostic characteristics that differentiate hip instability and FAI have not been identified. The purpose of this study was to examine a cohort of patients with minor acetabular dysplasia features in order to identify the preoperative clinical characteristics and imaging findings that differentiate patients with hip instability from patients with FAI. Methods: A retrospective cohort study of patients with borderline acetabular dysplasia was performed. Utilizing our institution’s hip preservation database, we identified 143 consecutive hips in 134 patients undergoing hip preservation surgery in the setting of borderline acetabular dysplasia. All patients were identified by prospective radiographic evaluation with an LCEA between 20° and 25°. Inclusion criteria included age 14-40 years and primary surgical treatment. Medical records were reviewed to determine patient demographics, details of clinical presentation, baseline patient-reported outcome scores, physical exam findings, plain radiographic findings, and the operative procedures performed. Statistical analyses were used to compare the clinical features and imaging parameters of the symptomatic acetabular dysplasia and FAI subgroups. Results: Of the 143 hips in the cohort, 39.2% (n = 56) had the diagnosis of symptomatic instability, while 60.8% (n = 87) had the diagnosis of FAI. The cohort included 109 females (76.2%) and 34 males (23.8%). Hips with instability (compared to FAI) had a significantly lower LCEA (21.8° vs. 22.8°; p < 0.001), lower ACEA (23.3° vs. 26.6°; p = 0.002), a higher AI (11.8° vs. 8.5°; p < 0.001), and a lower maximum alpha angle (54.4° vs. 61.1°; p = 0.001). The odds of instability increased 1.7 times for each one-degree decrease in LCEA, 1.4 times for each one-degree decrease in ACEA, and 1.1 times for each one-degree increase in acetabular inclination (all p < 0.003). Sex was strongly associated with the clinical diagnosis, with instability present in 48.6% of females compared to only 8.8% of males (p < 0.001). Patients with instability presented with significantly greater disability, as indicated by the modified Harris hip score, UCLA activity, SF-12 physical function, and HOOS (pain, activities of daily living, sports and recreation, and quality of life) scores (all p = 0.05). The symptomatic acetabular dysplasia subgroup had significantly greater range of motion in terms of internal rotation in flexion (IRF, 22.7° vs. 12.4°, p < 0.001) and total arc of rotational motion (IRF+ERF, 61.2° vs. 47.4°, p < 0.001). Lateral hip pain was present in 42.9% (24/56) of hips in the instability group compared to 25.3% (22/87) of hips in the impingement group (p = 0.03). Conclusions: We found significant differences in the clinical characteristics and radiographic features of the symptomatic acetabular dysplasia and FAI subgroups within the borderline dysplasia cohort. Patients with symptomatic instability tend to have lateral hip pain, greater functional limitations, higher range of motion, and a greater AI, while patients with impingement symptoms tend to have more limited range of motion (especially IRF), a greater ACEA, and a greater alpha angle.

Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia

2017 ◽  
Vol 45 (11) ◽  
pp. 2460-2467 ◽  
Author(s):  
Benjamin F. Ricciardi ◽  
Kara G. Fields ◽  
Catherine Wentzel ◽  
Bryan T. Kelly ◽  
Ernest L. Sink
Keyword(s):  
Cohort Study ◽  
Functional Outcomes ◽  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Group Versus ◽  
Outcome Scores ◽  
Symptomatic Acetabular Dysplasia

Background: Persistent acetabular dysplasia is a common reason for the failure of hip arthroscopic surgery; however, the effect of prior hip arthroscopic surgery on functional outcomes after subsequent periacetabular osteotomy (PAO) is unknown. Hypothesis/Purpose: The purpose of this study was to (1) compare demographic and radiological findings in patients who had and had not undergone previous hip arthroscopic surgery before PAO for symptomatic acetabular dysplasia and (2) compare the short-term, hip-specific patient-reported outcomes in these same patient populations. It was hypothesized that prior hip arthroscopic surgery is associated with worse early functional outcomes in PAO. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study design was utilized. Patients undergoing PAO were enrolled from a single-center, prospective hip preservation registry from March 2011 to April 2015. Patients with a minimum of 1-year clinical follow-up with preoperative and postoperative outcome scores undergoing PAO were eligible for inclusion (n = 93 patients; mean clinical follow-up, 24 months [range, 11-58 months]). The study group consisted of patients undergoing PAO for symptomatic hip dysplasia after prior hip arthroscopic surgery (PREVSCOPE group; 22 patients, 25 hips). Patients undergoing PAO without prior hip arthroscopic surgery (PAOALONE group; 71 patients, 85 hips) were included as a comparison group. Demographic and radiological variables were recorded. Postoperative functional outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool [iHOT-33]) were recorded at 6 months and annually postoperatively. Results: There were no demographic differences between the 2 groups at baseline. Acetabular version, femoral version, Tönnis grade, preoperative lateral center edge angle, and intraoperative procedures were not different between the 2 groups. At 1-year follow-up from the last hip surgical procedure, the mean (±SD) mHHS (73 ± 14 vs 86 ± 14, respectively; P < .001), HOS–Activities of Daily Living (84 ± 12 vs 93 ± 11, respectively; P = .007), HOS-Sport (62 ± 25 vs 85 ± 18, respectively; P < .001), and iHOT-33 (62 ± 21 vs 79 ± 20, respectively; P = .004) were decreased in the PREVSCOPE group versus the PAOALONE group. At last follow-up (mean, 18 months from the last hip surgical procedure), the mHHS and HOS-Sport were lower in the PREVSCOPE group versus the PAOALONE group. There was no difference in complication or reoperation rates between the 2 groups. Conclusion: Failed hip arthroscopic surgery before PAO for symptomatic hip dysplasia is associated with lower hip-specific functional outcomes within the first 1 year of follow-up despite similar baseline demographic and radiological characteristics. These differences persisted in certain outcome scores (mHHS, HOS-Sport) at last follow-up but were less pronounced than at 1 year.

scholarly journals Patient-Reported Outcomes in Young Adults with Osteonecrosis Secondary to Developmental Dysplasia of the Hip

2020 ◽  
Author(s):  
Andreas Roposch ◽  
Avi Marks ◽  
Dror Maor ◽  
Mario Cortina-Borja ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Quality Of Life ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Acetabular Dysplasia ◽  
Developmental Dysplasia ◽  
Maximum Score ◽  
Patient Reported ◽  
Hip Function ◽  
Dysplasia Of The Hip

Abstract Background Osteonecrosis of the femoral epiphysis is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study looks at determining the relationship between osteonecrosis of the femoral head and hip function, physical function and health status in adolescents and young adults treated for DDH.Methods We included 149 patients with a mean (and standard deviation) age of 19.7 (3.8) years with osteonecrosis following an open or closed reduction (1995–2005) and 32 age-matched patients without osteonecrosis. All patients completed valid and reliable patient-reported outcome measures in 2015/16 to quantify their hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for severity of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). We determined the association between the patient-reported outcomes and radiographic severity of osteonecrosis using mixed-effects regression analysis adjusted for age and acetabular dysplasia at study assessment, and number of prior operations.Results In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were − 4.7 (-10.26, 0.81), -1.03 (-9.29, 7.23) and 0.10 (-1.15, 1.18), respectively. Adjusted analysis stratified across radiographic severity of osteonecrosis showed only patients with Bucholz grade III had significantly worse hip function (p < 0.01) and physical function (p < 0.05) but no difference in health-related quality of life when compared to no osteonecrosis.Conclusion Osteonecrosis secondary to DDH is a relatively benign disorder in young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.

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