scholarly journals Modified triple pelvic osteotomy for adult symptomatic acetabular dysplasia: clinical and radiographic results at midterm follow-up

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Jiajun Wu ◽  
Yang Yang ◽  
Xiuhui Wang ◽  
Xiaoxiao Zhou ◽  
Changqing Zhang
Keyword(s):  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Symptomatic Acetabular Dysplasia

scholarly journals What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

2021 ◽  
Author(s):  
Mark A Roussot ◽  
Saif Salih ◽  
George Grammatopoulos ◽  
Johan D Witt
Keyword(s):  
Pelvic Tilt ◽  
Acetabular Dysplasia ◽  
Normal Population ◽  
Pubic Symphysis ◽  
Study Group ◽  
Compensatory Mechanism ◽  
Femoral Head Coverage ◽  
Normal Limits ◽  
Symptomatic Acetabular Dysplasia

Abstract To quantify the pelvic tilt (PT) in patients with symptomatic acetabular dysplasia and determine if it represents a compensatory mechanism to improve femoral head coverage, we studied a cohort of 16 patients undergoing 32 bilateral staged PAOs for acetabular dysplasia and compared this to a matched cohort of 32 patients undergoing PAO for unilateral acetabular dysplasia all with >1 year follow-up. The change in PT was determined with two validated methods, namely, the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac index (PS-SI). Despite an improvement in the lateral centre-edge and Tönnis angles to within normal limits following PAO, patients with unilateral and bilateral acetabular dysplasia have similar PT pre-operatively (8° ± 5°) and post-operatively (9° ± 5°). A change of >5° was observed in only six patients (13%) using the SFP angle, and five patients (10%) using the PS-SI, all increased (posterior rotation of the pelvis). No patients were observed to have a change in PT >10°. The observed PT in our study group is equivalent to that found in the normal population and in patient with symptomatic acetabular retroversion. These findings all suggest that PT is morphological rather than a result of a compensatory mechanism, and even if it was compensatory, it does not appear to reverse significantly following PAO. The target for acetabular reorientation, therefore, remains constant.

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.

scholarly journals Long-Team Follow up Study of Chiari Pelvic Osteotomy for Coxarthrosis with Severe Acetabular Dysplasia.

2003 ◽  
Vol 52 (1) ◽  
pp. 10-17
Author(s):  
Taketoshi Kanazawa ◽  
Takahiro Okawa ◽  
Manabu Kubo ◽  
Masaru Kumagai ◽  
Shinichiro Kume ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Follow Up Study ◽  
Chiari Pelvic Osteotomy

scholarly journals Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

2019 ◽  
Vol 13 (2) ◽  
pp. 172-179 ◽  
Author(s):  
R. Badrinath ◽  
J. D. Bomar ◽  
D. R. Wenger ◽  
S. J. Mubarak ◽  
V. V. Upasani
Keyword(s):  
San Diego ◽  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Developmental Dysplasia ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Medial Cortex ◽  
Retrospective Comparison ◽  
Dysplasia Of The Hip

Purpose Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH. Methods We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria. Results Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458). Conclusion The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient’s specific acetabular deficiency Level of evidence Level III retrospective comparison

Factors Predicting the Outcomes of Incomplete Triple Pelvic Osteotomy

2017 ◽  
Vol 27 (6) ◽  
pp. 608-614 ◽  
Author(s):  
Engin Eceviz ◽  
Esat Uygur ◽  
Mehmet S. Söylemez ◽  
Abdullah Eren
Keyword(s):  
Clinical Outcomes ◽  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Crossover Sign ◽  
Patient Age ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Patient Âgé ◽  
Osteoarthritis Progression

Introduction In the present study, we identified factors affecting the outcomes of patients who underwent incomplete triple pelvic osteotomies due to acetabular dysplasia. Methods Data on a total of 58 hips in 50 patients for whom adequate data were available and who had undergone appropriate follow-up were retrospectively evaluated. We used Ömeroğlu scores for radiological evaluation, Harris Hip Scores for clinical evaluation, Tönnis scores to evaluate osteoarthritis progression and a modified Clavien-Dindo classification to evaluate complications. Results The average patient age was 23.26 (14-47) years, and the average follow-up duration 105.59 (18-191) months. The complication rate was 10.3%, and complications negatively influenced clinical outcomes. Patients with radiologically poorer outcomes had more advanced osteoarthritis. We found minimal improvements in lateral centre edge angle (LCEA), refined centre-edge angle (RCEA), and lateral acetabulum head index (LAHI) were associated with osteoarthritis progression and that good improvements in LCEA, RCEA, acetabular angle (AA), and LAHI were associated with radiological outcomes. Neither patient age at the time of operation nor development of a postoperative relative crossover sign affected osteoarthritis progression or clinical or radiological outcomes. Conclusions The most important factors influencing clinical outcomes were complications. However, neither postoperative acetabular retroversion nor a positive supra-equatorial crossover sign (often viewed as prognostically negative) directly affected clinical outcomes. When treating patients with acetabular dysplasia, either inadequate correction or overcorrection may negatively affect outcomes. In such patients, an incomplete triple pelvic osteotomy (allowing controlled correction) is both safe and effective.

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.

Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?

2017 ◽  
Vol 45 (11) ◽  
pp. 2468-2475 ◽  
Author(s):  
Daisuke Hara ◽  
Satoshi Hamai ◽  
Jun-ichi Fukushi ◽  
Ken-ichi Kawaguchi ◽  
Goro Motomura ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Time Of Surgery ◽  
Center Edge ◽  
Number Of Patients ◽  
Ucla Score ◽  
The Mean ◽  
Grade 3 ◽  
Symptomatic Acetabular Dysplasia

Background: Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear. Purpose: To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d’Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO. Results: The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4. Conclusion: Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.

scholarly journals Hypermobility, age 40 years or older and BMI >30 kg m−2 increase the risk of complications following peri-acetabular osteotomy

2020 ◽  
Author(s):  
Saif Salih ◽  
Floris Groen ◽  
Fahad Hossein ◽  
Johan Witt
Keyword(s):  
Acetabular Dysplasia ◽  
Major Complication ◽  
Direct Consequence ◽  
High Volume ◽  
Clavien Classification ◽  
Age At Surgery ◽  
Grade Ii ◽  
Symptomatic Acetabular Dysplasia ◽  
Pharmaceutical Interventions

Abstract The peri-acetabular osteotomy (PAO) is a powerful surgical procedure for correcting symptomatic acetabular dysplasia, but it carries the potential for significant surgical complications. This study aims to determine the complication profile of PAO in a series performed by an experienced single surgeon. This was as retrospective review of 223 hips in 200 patients (23 bilateral, 22 males and 201 females). Complication data were collected from notes and radiographic review and graded according to a modified Dindo–Clavien classification. Each hip could be recorded as having more than one complication. Mean age at surgery was 28.8 years (range 13-48), mean weight was 70.9 kg (range 45–115 kg). Diagnosis was dysplasia in 185 hips, retroversion in 25 and a combination in 13. Mean follow-up was 26 months. In all, 61.4% of hips (137) had no complications; 74.0% had no complications or a Grade I complication (one that did not change management); 52 hips (23%) required pharmaceutical interventions (Grade II complications). Six hips (2.7%) suffered a major complication (Grade III or IV) as a direct consequence of the PAO. There were no Grade V complications (death). Hypermobility (Beighton’s score of ≥6, Odds ratio (OR) 2.525 P = 0.041), age 40 years or older (OR 3.126 P = 0.012) and BMI &gt;30 (OR 2.506 P = 0.031), but not Tonnis grade (P = 0.193) increased the risk of more severe complications following a PAO. This single surgeon series from a high volume centre demonstrates that age 40 years or older and BMI &gt;30 kg m−2 and hypermobility increase the risk of more severe of complications.

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