Combined Periacetabular and Femoral Osteotomies for Severe Hip Deformities

Abstract

Periacetabular osteotomy (PAO) is an effective acetabular reorientation technique for treatment of symptomatic acetabular dysplasia. In hips with severe deformities, an adjunctive femoral osteotomy (PFO) may optimize correction, joint stability, and congruency. We analyzed the clinical and radiographic results of combined PAO/PFO in treating severe hip deformities. Second, we compared the clinical results of patients treated with PAO/ PFO with patients treated with isolated PAO for lesser deformities. Twenty-five patients (28 hips) treated with PAO/PFO were reviewed and followed a minimum of 16 months (mean, 44 months). The matched PAO cohort included 25 patients (28 hips). For the PAO/PFO group, the average Harris hip score improved from 60.9 to 86.3. Eighty-nine percent of the patients demonstrated at least a 10-point improvement in the hip score and 75% had a Harris hip score over 80 points. Radiographic evaluation demonstrated consistent deformity correction. The PAO/ PFO group had a lower average Harris hip score preoperatively, yet hip function after surgery was comparable between groups. These data indicate combined PAO/ PFO is associated with improved hip function in most patients. These clinical results are comparable to those obtained with isolated PAO for lesser hip deformities.

Periacetabular osteotomy: a review of swiss experience

“…However, Clohisy et al [31] showed that even in hips with severe acetabular dysplasia with subluxated hips or a false acetabulum a good or excellent clinical result could be achieved in 14 of 16 hips at 4 years follow-up. Optimal reconstruction may require additional femoral osteotomy in hips with severe femoral deformities and articular mismatch to optimize congruency and joint stability [32].…”

Does Previous Reconstructive Surgery Influence Functional Improvement and Deformity Correction After Periacetabular Osteotomy?

“…Additionally, improvement in hip pain and function scores occurs in 73% to 97% of patients [5,7,11,20,25,30,31]. The indications for PAO continue to expand as the interest and utilization of this procedure continue to grow, with several authors combining PAO with other procedures such as surgical dislocation [1] and proximal femoral osteotomy (PFO) [9] for the treatment of complex structural hip deformities.…”

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

“…healing 1,2,[7][8][9][10][11][12][13][14][15][16] . Nevertheless, the published clinical evidence regarding this procedure is mostly limited to single-surgeon or single-institution retrospective case series 17 .…”