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

Introduction: Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups. Results: Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92. Conclusion: We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia. Summary: This study attempts to define 3D CT characteristics to help distinguish between patients with impingement-based vs instability-based symptoms of borderline acetabular dysplasia.

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

Bone and Joint Research ◽

10.1302/2046-3758.95.bjr-2019-0155.r1 ◽

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546519881421 ◽

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.

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Acetabular Dysplasia: Three-Dimensional Deformity Predictors of the Diagnosis of Symptomatic Instability Treated with Periacetabular Osteotomy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00426 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0042

Author(s):

Maria Schwabe ◽

Cecilia Pascual-Garrido ◽

John Clohisy ◽

Elizabeth Graesser ◽

Jeffrey Nepple

Keyword(s):

Low Dose ◽

Acetabular Dysplasia ◽

Periacetabular Osteotomy ◽

Alpha Angle ◽

Three Dimensional ◽

Acetabular Coverage ◽

Low Dose Ct ◽

Femoral Version ◽

Center Edge ◽

Hip Morphology

Objectives: Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups. Results: Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92. Conclusion: We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia.

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Patient Characteristics and Early Functional Outcomes of Combined Arthroscopic Labral Refixation and Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia

The American Journal of Sports Medicine ◽

10.1177/0363546516651829 ◽

2016 ◽

Vol 44 (10) ◽

pp. 2518-2525 ◽

Cited By ~ 22

Author(s):

Benjamin F. Ricciardi ◽

Stephanie W. Mayer ◽

Kara G. Fields ◽

Catherine Wentzel ◽

Bryan T. Kelly ◽

...

Keyword(s):

Functional Outcomes ◽

Acetabular Dysplasia ◽

Periacetabular Osteotomy ◽

Patient Characteristics ◽

Labral Refixation ◽

Symptomatic Acetabular Dysplasia

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

The American Journal of Sports Medicine ◽

10.1177/0363546517710011 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2460-2467 ◽

Cited By ~ 16

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.

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

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab086 ◽

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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Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?

The American Journal of Sports Medicine ◽

10.1177/0363546517707942 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2468-2475 ◽

Cited By ~ 8

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.

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Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia

10.21203/rs.3.rs-22059/v4 ◽

2020 ◽

Author(s):

Yoshiki Takahashi ◽

Naonobu Takahira ◽

Katsufumi Uchiyama ◽

Kensuke Fukushima ◽

Mitsutoshi Moriya ◽

...

Keyword(s):

Physical Function ◽

Acetabular Dysplasia ◽

Periacetabular Osteotomy ◽

Weight Bearing ◽

Activity Participation ◽

Full Weight Bearing ◽

Sports Activity ◽

Before And After ◽

Curved Periacetabular Osteotomy ◽

Sports Activities

Abstract Background: Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO.Methods: A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO.Results: The pre- and post-operative sports activity participation rates were 55.8% and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier.Conclusions: Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.

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