Periacetabular Osteotomy for Developmental Dysplasia of the Hip and Femoroacetabular Impingement

Abstract

Background: Periacetabular osteotomy (PAO) is a well-recognized procedure for the treatment of hip dysplasia in young adults and can be used for the surgical management of femoroacetabular impingement (FAI) with acetabular retroversion. The aim of this study was to use a national database to assess the outcomes of PAO for developmental dysplasia of the hip (DDH) and for FAI. Methods: All patients in whom an isolated PAO had been performed between January 2012 and February 2019 were identified in the Non-Arthroplasty Hip Registry (NAHR). Their outcomes were assessed using the EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool (iHOT)-12 preoperatively and then at 6 months, 12 months, and 2 years postoperatively. Results: Six hundred and thirty (630) PAOs were identified, with 558 (89%) performed for DDH and 72 (11%) performed for FAI. Most patients (90%) were female. The mean age in the DDH group (31.2 years) was significantly higher (p < 0.0001) than that in the FAI group (26.5 years). There were no other significant between-group demographic differences. Preoperatively and at each follow-up time-period, iHOT-12 scores were better in the DDH group than in the FAI group; however, only the preoperative scores differed significantly. There was significant improvement between the preoperative and 6-month iHOT-12 and EQ-5D index scores in both the DDH and the FAI group. This improvement was maintained at 12 months postoperatively, by which time almost 90% of the patients had achieved the minimum clinically important difference (MCID) in their iHOT-12 score. Conclusions: This study shows that PAO is a successful surgical intervention for DDH and FAI in the short term, with significant improvement in patient-reported outcome scores that is maintained up to 2 years postoperatively. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of early outcomes of arthroscopic labral repair or debridement

“…Limitations. Limitations of the NAHR dataset have been discussed previously: 44 most importantly, missing data, and the fact that longer term follow-up beyond 12 months has poor compliance in the registry. The NAHR committee are working to address this, including contacting and re-engaging those patients who have given consent.…”

Registry Studies Use Inconsistent Methods to Account for Patients Lost to Follow-up, and Rates of Patients LTFU Are High

“… 25 NKLR 5517 ACLR KOOS Male, younger, more ACLR revisions 2 year: 36 1 Holleyman et al. 38 NAHR 630 Periacetabular osteotomy for DDH or FAI EQ-5D, iHOT12 Younger age iHOT-12: Pre-op: 10 6 month: 48 12 month: 47 2 year: 85 EQ-5D: Pre-op: 8 6 month: 47 12 month: 46 2 year: 79 4 Maempel et al. 11 NAHR 88 FAI EQ-5D, iHOT12 1 year † : 19 3 DHAR, Danish Hip Arthroscopy Registry; DKRR, Danish Knee Ligament Reconstruction Registry; NKLR, Norwegian Knee Ligament Registry; NLR, United Kingdom National Ligament Registry; NAHR, United Kingdom Non-Arthroplasty Hip Registry; SNKLR, Swedish National Knee Ligament Registry; ACLR, anterior cruciate ligament reconstruction; MCLR, medial cruciate ligament reconstruction; PCLR, posterior cruciate ligament reconstruction; DDH, developmental dysplasia of the hip; FAI, femoroacetabular impingement; HAGOS, Copenhagen Hip and Groin Outcome Score; iHOT12, 12 item International Hip Outcome Tool; EQ-5D-3L, EuroQol-5D-3L; EQ-5D, EuroQol-5D; VAS, visual analog scale; HSAS, Hip Sports Activity Scale; KOOS, Knee Injury and Osteoarthritis Outcome Score.…”

“…Twelve papers 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 referenced a validation study only, and an additional 3 articles 7 , 19 , 20 referenced both a validation study and carried out a dropout analysis. Two validation studies were carried out on the dataset of 2 registries: the SNKLR and DKRR.…”

“…From the included studies, Holleyman et al. 38 conducted a different sensitivity analysis to adjust for differences in demographics between responders and nonresponders. This was carried out by creating a cohort (“overall cohort”) with bootstrapping (random sampling with replacement) responders and nonresponders, followed by creating another cohort (“responder cohort”) via the same process of random sampling from all of the responders.…”

The Global Research Trends and Hotspots on Developmental Dysplasia of the Hip: A Bibliometric and Visualized Study

“…From 2006 to 2012, the representative keywords were innominate osteotomy, low-friction arthroplasty, arthritis, placement, and nature history, which reflected the development of diverse therapeutic methods. While over the recent 4 years, from 2017 to 2020, the most frequently encountered keywords were "clinical outcome" (34)(35)(36), "risk factor" (52), "femoroacetabular impingement" (53), "predictor" (54), "arthroscopy" (55), "morphology" (56), and "anteversion" (57) and may continue to be the research hotspots in the near future.…”