Hip dysplasia in adolescence: osteotomy in childhood improves the results of periacetabular osteotomy in adolescents and young adults

Abstract

Aims Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. Methods Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment. Results Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups. Conclusion The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J 2022;104-B(7):775–780.

Clinical results of periacetabular osteotomy with structural bone allograft for the treatment of severe hip dysplasia

“…Previous studies have revealed favourable intermediate-to-long-term clinical outcomes of PAO. 14,21,22,36 Lerch et al 9 reported 88% survivorship at ten years, 61% at 20 years, and 29% at 30 years after Bernese PAO with either THA, OA progression, or Merle d’Aubigné score < 15 as the endpoint. Wells et al 10 reported 85% survivorship at ten years and 80% survivorship at 15 years after PAO, with THA as the endpoint.…”

Important matters that need attention

“…However, there are still very significant question marks over how and when periacetabular osteotomy should be performed, and what adjunctive treatments are needed. [21][22][23][24][25][26][27][28][29] A great deal more research is needed.…”

News in paediatric orthopaedic surgery: an overview of the latest advances in paediatric orthopaedics and traumatology (2020–2023)

“…Kołodziejczyk et al evaluated the hips of adolescents who had or had not been operated on during infancy for congenital hip dislocation and the hips of adults with congenital hip dislocation during infancy who had not undergone previous surgery; they concluded that surgical treatment of congenital hip dislocation during infancy has a beneficial effect on the outcome of periacetabular osteotomies performed in adolescence and early adulthood. Particularly, Kołodziejczyk et al highlighted that the correction of radiological parameters and clinical outcome of periacetabular osteotomies were better in patients with congenital hip dislocation undergoing surgery during infancy [ 22 ].…”