Does Previous Pelvic Osteotomy Compromise the Results of Periacetabular Osteotomy Surgery?

Abstract

Background As the Bernese periacetabular osteotomy (PAO) has grown in popularity, specific indications and the results in patients treated for those indications need to be evaluated. Currently, although many patients undergo PAO after having had prior pelvic osteotomy, there is limited information regarding the efficacy of the PAO in these patients.Questions/purposes The purpose of this study was to compare the (1) early pain, function, activity, and quality of life outcomes; (2) radiographic correction; and (3) major complications and failures between patients who underwent PAO after prior pelvic reconstruction versus those who had a PAO without prior surgery. Methods Between February 2008 and January 2012, 39 patients underwent PAO after prior pelvic osteotomy at one of 11 centers and were entered into a collaborative multicenter database. Of those, 34 (87%) were available for followup at a mean of 2.5 years (range 1-5 years). This group was compared with a matched group of 78 subjects, of whom 71 (91%) were available for followup at a similar interval. We compared clinical outcomes including UCLA activity score, SF-12, and Hip Disability and Osteoarthritis Outcome Score (HOOS); radiographic measures-anterior and lateral center-edge angle and acetabular inclination (AI)-and reoperations, major complications, and conversions to total hip arthroplasty. CI,) than the primary cohort. The revision cohort achieved a smaller average radiographic correction than in patients undergoing PAO without prior pelvic surgery. The mean correction in AI was less dramatic when directly comparing the revision and comparison groups (À12°to À17°, p\ 0.001, SD 2.3-8.5). Although there was no difference in severe complications requiring further surgery, there were two conversions to hip arthroplasty (p = 0.109; 95% CI, 0.004-2.042) in the study group. Conclusions PAO performed after prior pelvic surgery is associated with improvements in pain, function, radiographic correction, and early complication rates, but the improvements observed at short-term followup were smaller and more variable than those seen in patients who had not undergone prior pelvic surgery. We recommend considering PAO for residual deformities after prior osteotomy to improve function and quality life but warning patients of potential ceiling effects with a second periacetabular surgery. Level of Evidence Level III, therapeutic study.

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

“…14 Other studies examining the outcomes of PAO in the revision setting have focused on patients who had undergone previous pelvic osteotomy. 2,26,33 In a multicenter study, Stambough et al 33 found that patients who had undergone prior pelvic osteotomy did reach a threshold for clinical improvements; however, the overall magnitude of improvements in the pain and functional domains was smaller at a mean 2.5 years of follow-up relative to a group of patients without prior surgery. Polkowski et al 26 also found improvements after PAO in patients who had undergone prior pelvic osteotomy; however, the mean mHHS improved only 11 points from preoperative levels.…”

Complications and Short-Term Patient Outcomes of Periacetabular Osteotomy for Symptomatic Mild Hip Dysplasia

“…Patients who failed to improve by MIC at final follow-up fell into 3 primary groups: patients undergoing revision hip preservation surgery at the time of PAO; patients with a postoperative complication; or patients with a more complex deformity or collagen disease in addition to their acetabular dysplasia. PAO in the setting of prior hip preservation attempts may have inferior outcomes to the nonrevision setting (38, 39). The effect of prior hip arthroscopy on outcomes after PAO remain unclear, however, Kain et al (40) did not find a prior hip arthroscopy compromises functional outcomes of PAO.…”

Correlation of Patient-Reported Outcomes After Periacetabular Osteotomy With Femoral Head Coverage and Acetabular Orientation: A Single-Center Cohort Study

“…15,57 Our study had some limitations in determining dysplasia measurements through radiographs, which have been highlighted in previous studies. 44,49 Although we assessed actabular dysplasia in 3 dimensions using Hip2Norm software based on AP pelvis radiographs, 56 3-dimensional computed tomography reconstruction, which was not available for all our patients, would provide more detailed analyses. In addition, because of the influence of pelvic incidence on acetabular orientation, the degree of overlap between what might be considered an essentially normal acetabular orientation versus dysplastic orientation can still vary from patient to patient, further emphasizing the importance of physical examination.…”

“…The second limitation is that our results are still short term; hence, longer term longitudinal studies will be needed to further validate our findings in regard to joint survivorship. 30,44 Additionally, despite the HOOS being validated for use across multiple hip abnormalities, because our patients were commonly young and healthy with active lifestyles, we must consider the possible presence of floor or ceiling effects in our interpretation of PROM scores. 30 What represents a ''healthy/sustainable'' relationship between the femoral head and acetabulum is complex, as there are a near infinite number of bony morphological and dynamic/functional configurations that can exist along a spectrum of stability.…”