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 LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Clarabelle DeVries ◽  
Jeffrey J Nepple ◽  
Lucas Fowler ◽  
Sean Akers ◽  
Gail Pashos ◽  
...  
Keyword(s):  
Femoral Head ◽  
Normative Data ◽  
Low Dose ◽  
Periacetabular Osteotomy ◽  
Femoral Head Coverage ◽  
Edge Angle ◽  
Center Edge ◽  
Two Sectors ◽  
Posterior Sector ◽  
Center Edge Angle

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.

scholarly journals Comparison of four parameters to assess acetabular dysplasia and acetabular dysplasia rates in primary hip osteoarthritis patients: A study in Turkish population

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901876803 ◽  
Author(s):  
Oktay Adanir ◽  
Gazi Zorer
Keyword(s):  
Femoral Head ◽  
Acetabular Dysplasia ◽  
Hip Prosthesis ◽  
Hip Osteoarthritis ◽  
High Rate ◽  
Femoral Head Coverage ◽  
Coverage Ratio ◽  
Total Hip ◽  
Center Edge ◽  
Age At Surgery

Introduction: Hip osteoarthritis is an important orthopedic problem frequently observed in the elderly. Acetabular dysplasia (AD) is one of the pathologies that cause coxarthrosis. Nearly 20–45% of primary or idiopathic hip osteoarthritis is linked to AD. In our country, there are few studies on this topic. We measured the center–edge (CE) angle, Sharp’s angle, acetabular depth, and femoral head coverage ratio on pelvis anteroposterior radiographs of patients with primary coxarthrosis and calculated the dysplasia rates. Patients and method: Age at surgery and sex of the patients; and CE angle, Sharp’s angle, acetabular depth, and femoral head coverage ratio for both operated and opposite hips were evaluated in 223 total hip prosthesis–performed patients with coxarthrosis. Also the distribution of mean age at surgery, sex of patients, dysplasia rates of operated hips, and bilateral dysplasia rates were calculated. Results: The right to left ratio of operated hips was 104/119. Female to male ratio was 163/60 (2.7/1), for those with CE angle below 20° it was 123/30 (4.1/1), and it was 40/30 (1.3/1) with CE angle above 20°. Mean age of patients at surgery was 56.9 (±11.4) years. CE angle less than 20° was found in 68.6% of patients, acetabulum depth less than 9 mm was found in 75.3%, Sharp’s angle was more than 45° in 65.9%, and femoral head coverage ratio was less than 70% in 70.3% of patients. Conclusions: We identified a high rate of AD in primary coxarthrosis patients undergoing total hip arthroplasty in the study population.

scholarly journals Patient-Reported Outcomes of Periacetabular Osteotomy from the Prospective ANCHOR Cohort Study

2017 ◽  
Vol 99 (1) ◽  
pp. 33-41 ◽  
Author(s):  
John C. Clohisy ◽  
Jeffrey Ackerman ◽  
Geneva Baca ◽  
Jack Baty ◽  
Paul E. Beaulé ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Reported Outcomes ◽  
Periacetabular Osteotomy ◽  
Patient Reported

scholarly journals Periacetabular Osteotomy for the Treatment of Acetabular Dysplasia Associated with Major Aspherical Femoral Head Deformities

2007 ◽  
Vol 89 (7) ◽  
pp. 1417-1423 ◽  
Author(s):  
John C. Clohisy ◽  
Ryan M. Nunley ◽  
Madelyn C. Curry ◽  
Perry L. Schoenecker
Keyword(s):  
Femoral Head ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy

Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities

2018 ◽  
Vol 100-B (12) ◽  
pp. 1551-1558 ◽  
Author(s):  
J. C. Clohisy ◽  
C. Pascual-Garrido ◽  
S. Duncan ◽  
G. Pashos ◽  
P. L. Schoenecker
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Alpha Angle ◽  
Young Patients ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Short Term ◽  
Patient Reported ◽  
The Mean

AimsThe aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities.Patients and MethodsBetween 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle.ResultsThe mean follow-up was 3.3 years (2 to 4.6). The modified Harris Hip Score improved by 33.0 points from 53.5 preoperatively to 83.4 postoperatively (p = 0.03). The Western Ontario McMasters University Osteoarthritic Index score improved by 30 points from 62 preoperatively to 90 postoperatively (p = 0.029). All radiological parameters showed significant improvement. There were no long-term disabilities and none of the hips required early conversion to total hip arthroplasty.ConclusionFHRO combined with a PAO resulted in clinical and radiological improvement at short-term follow-up, suggesting it may serve as an appropriate salvage treatment option for selected young patients with severe symptomatic hip deformities.

scholarly journals Addressing intraarticular pathology at the time of anteverting periacetabular osteotomy for acetabular retroversion is associated with better short-term patient-reported outcomes

2021 ◽  
Author(s):  
Joseph A Panos ◽  
Claudia N Gutierrez ◽  
Cody C Wyles ◽  
Joshua S Bingham ◽  
Kristin C Mara ◽  
...  
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Patient Reported Outcome Measures ◽  
Developmental Dysplasia ◽  
Current Data ◽  
Acetabular Retroversion ◽  
Labral Repair ◽  
Patient Reported ◽  
Head Neck ◽  
Neck Junction

Abstract Periacetabular osteotomy (PAO) is effective in the management of developmental dysplasia of the hip and femoroacetabular impingement secondary to acetabular retroversion. During anteverting PAO for acetabular retroversion, the need for both labral treatment and femoral head–neck junction osteochondroplasty remains equivocal. Accordingly, this study evaluated patient-reported outcome measures (PROM) and reoperation rates after anteverting PAO with or without intraarticular intervention. Cases of anteverting PAO performed at a single institution between November 2009 and January 2016 were retrospectively reviewed. Patients were divided into three groups: no intervention and intraarticular intervention with arthrotomy or arthroscopy. Subsequently, patients were reclassified by the intraarticular procedure performed at surgery into major (labral repair, femoral head–neck osteochondroplasty) and minor (labral debridement, femoral/acetabular chondroplasty) groups. The cohort was 75% female, median age was 19.5 years and mean body mass index was 25.0 kg/m2. Preoperative to postoperative improvement was compared to minimal clinically important differences (MCID) for eight PROM. Patients receiving major interventions exceeded MCID in a greater proportion of PROM compared to minor and no intervention groups (P &lt; 0.007); major or minor interventions did not increase the risk of reoperation over no intervention (P ≥ 0.39). Based on the current data, surgeons performing anteverting PAO for acetabular retroversion should perform arthroscopic or open labral repair and assess for impingement after the correction and perform a head–neck junction osteochondroplasty if indicated.

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 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.

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