Analysis of Factors Affecting Early Functional Recovery of Bernese Periacetabular Osteotomy

Abstract

Objectives: To explore factors affecting the efficacy of Bernese periacetabular osteotomy for the treatment of hip dysplasia.Methods: A retrospective study was conducted on 44 patients with hip dysplasia who underwent Bernese periacetabular osteotomy with a modified Smith-Peterson approach between January 2017 and November 2019. Among them, 40 were women and four were men. The average age was 31.2 AE 9.4. Preoperative and postoperative imaging parameters were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale scores, and modified Harris hip score (MHHS) were observed. MHHS were divided into three clinically relevant categories: poor (<70 points), good (70-85 points), and excellent (86-91 points). Patient demographic data, as well as preoperative and postoperative radiographic parameters, were subjected to univariate logistic regression analysis. Multiple regression analysis was used to determine factors influencing postoperative MHHS. Results:The follow-up time was 1.0-3.9 years after surgery, with an average of 1.6 years. By the last follow-up, MHHS increased from 70 points before surgery to 91 points after surgery (P < 0.001), WOMAC pain score decreased from 4 points before surgery to 0 points after surgery (P < 0.001). WOMAC functional score decreased (Preoperative: 18.0 [4.0]; Postoperative: 4.0 [0], P = 0.004). Six patients had sensory disturbance of the lateral femoral cutaneous nerve, four of which recovered completely during follow-up. No other complications related to surgical approach, osteotomy, acetabular displacement, acetabular fixation, and postoperative stage were found. There was no significant vascular, nerve, or visceral injuries in any of the patients. On multiple regression analysis, the probability of the postoperative modified Harris hip score of a hip joint with a preoperative lateral center edge angle ≥4.5 being classified as excellent was six times that of angles <4.5 (Exp[β]: 6.249, 95% CI: 1.03-37.85, P = 0.046). Regression analysis of other factors found no significant correlation with postoperative functional scores. Conclusion:Overall functional scores post-PAO significantly improved, and pain symptoms were significantly reduced.Patients with a preoperative lateral center edge angle ≥4.5 had better joint function after surgery.

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

“…In the studies referenced above, hip-related pain, function and quality of life were measured using common hip-related questionnaires that have been shown to be reliable and valid in individuals with hip pathology, including (i) the modified Harris Hip Score or the standard Harris Hip Score (mHHS/HHS; n = 15) [ 3 , 7 , 29 , 31–33 , 35 , 36 , 38–41 , 43 , 44 , 47 ], (ii) the Hip Disability and Osteoarthritis Outcomes Score (HOOS; n = 10) [ 3 , 29 , 32 , 35 , 37 , 38 , 40 , 42 , 43 , 46 ], (iii) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; n = 7) [ 33 , 35 , 38 , 39 , 44 , 46 , 47 ], (iv) the Copenhagen Hip and Groin Outcome Score (HAGOS; n = 3) [ 23 , 28 , 34 ], (v) the International Hip Outcome Tool (iHOT-12; n = 1) [ 32 ], (vi) the Patient-Reported Outcomes Measurement Information System (PROMIS; n = 1) [ 32 ], (vii) The Short Form 36 Health Survey Questionnaire (SF-36; n = 2) [ 33 , 42 ], (viii) the Numeric Pain Rating scale (NPRS; n = 1) [ 34 ], (ix) the Visual Analogue Scale (VAS; n = 1) [ 32 ], and the Non-Arthritic Hip Score (NAHS; n = 1) [ 45 ].…”

“…Of the overall included studies ( n = 23), 14 studies evaluated pain intensity in persons with symptomatic AD before and after PAO [ 3 , 23 , 28 , 29 , 32 , 33 , 35 , 37–40 , 42 , 44 , 47 ], using several PROs, included the HOOS ( n = 8) [ 3 , 32 , 35 , 37 , 38 , 40 , 42 , 48 ], WOMAC ( n = 6) [ 33 , 35 , 38 , 39 , 44 , 47 ], HAGOS ( n = 2) [ 28 , 34 ], VAS scale ( n = 1) [ 32 ] and NPRS ( n = 1) [ 34 ]. Average scores of pain intensity before and after PAO in persons with symptomatic AD are provided in Table I .…”

“…Of the 14 studies that evaluated pain intensity in persons with symptomatic AD, 6 studies used prospective study designs monitoring pain changes over 4 months to 2 years following PAO (total combined sample = 857) [ 3 , 28 , 32–35 ]. Eight studies used retrospective study designs reviewing reports that evaluated pain intensity after 2 years [ 37 , 40 , 42 , 44 , 48 ], 3 years [ 38 ], 5 years [ 39 ] and 6 years [ 47 ] following PAO, respectively (total combined sample = 625). Across studies, there were significant improvements in pain intensity among persons with symptomatic AD up to 6 years following PAO (all studies reported statistically significant improvements; P < 0.05; total combined sample = 1482) [ 3 , 23 , 28 , 29 , 32 , 33 , 35 , 37–40 , 42 , 44 , 47 ].…”

“…Of the overall included studies ( n = 23), 19 evaluated hip-related function in persons with symptomatic AD before and after PAO [ 3 , 7 , 31–45 , 47 , 48 ], using several PROs, including the mHHS/HHS ( n = 15) [ 3 , 7 , 29 , 31–33 , 35 , 36 , 38–41 , 43 , 44 , 47 ], HOOS ( n = 7) [ 3 , 29 , 32 , 35 , 37 , 38 , 42 ], WOMAC ( n = 4) [ 33 , 38 , 39 , 44 ], iHOT-12 and the PROMIS (physical function subscale; n = 1) [ 32 ], HAGOS ( n = 1) [ 34 ], and NAHS (1) [ 45 ]. Average scores on hip-related function before and after PAO in persons with symptomatic AD are provided in Table I .…”

“…To the best of our knowledge, this is the first review to synthesize evidence regarding patient-reported and mobility-related outcomes following PAO in persons with symptomatic AD as well as to reflect on future research for capturing real-world effects of PAO in this patient population. The current narrative review included 23 studies (9 prospective [ 3 , 7 , 23 , 28 , 31 , 32 , 33 , 34 , 35 ] and 14 retrospective [ 22 , 29 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]) that presented patient-reported and mobility-related outcomes in persons with symptomatic AD, both before and after PAO. Postoperatively following PAO, there were consistent improvements in PROs (pain, function, quality of life and self-reported PA).…”