Periacetabular osteotomy to treat hip dysplasia: a systematic review of harms and benefits

Tønning, Lisa Urup; O'Brien, Michael; Semciw, Adam; Stewart, Christopher M.; Kemp, Joanne L; Mechlenburg, Inger

doi:10.1007/s00402-022-04627-7

Cited by 4 publications

(2 citation statements)

References 46 publications

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“…Realignment pelvic osteotomies such as PAO are associated with a significant risk of major complications, ranging from 5% to 37%, and sometimes lead to acetabular defects. [34][35][36] In contrast, a shelf operation does not affect the shape of the pelvic ring and only rarely interferes with future THA, if needed. 22,37,38 However, shelf operations are unable to improve the coverage of the femoral head with true acetabular articular cartilage, and they LCEA, lateral centre-edge angle; N/A, not applicable.…”

Section: Discussionmentioning

confidence: 99%

The modified Spitzy shelf acetabuloplasty for the dysplastic hip

Oe,

Iida,

Otsuki

et al. 2023

Bone Jt Open

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AimsAlthough there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty.MethodsBetween November 2000 and December 2016, we retrospectively evaluated 144 consecutive hip procedures in 122 patients a minimum of five years after undergoing modified Spitzy shelf acetabuloplasty for acetabular dysplasia including osteoarthritis (OA). Our follow-up rate was 92%. The mean age at time of surgery was 37 years (13 to 58), with a mean follow-up of 11 years (5 to 21). Advanced OA (Tönnis grade ≥ 2) was present preoperatively in 16 hips (11%). The preoperative lateral centre-edge angle ranged from -28° to 25°. Survival was determined by Kaplan-Meier analysis, using conversions to total hip arthroplasty as the endpoint. Risk factors for joint space narrowing less than 2 mm were analyzed using a Cox proportional hazards model.ResultsThe mean Merle d'Aubigné clinical score improved from 11.6 points (6 to 17) preoperatively to 15.9 points (12 to 18) at the last follow-up. The survival rates were 95% (95% confidence interval (CI) 91 to 99) and 86% (95% CI 50 to 97) at ten and 15 years. Multivariate Cox regression identified three factors associated with radiological OA progression: age (hazard ratio (HR) 2.85, 95% CI 1.05 to 7.76; p = 0.0398), preoperative joint space (HR 2.41, 95% CI 1.35 to 4.29; p = 0.0029), and preoperative OA (HR 8.34, 95% CI 0.94 to 73.77; p = 0.0466).ConclusionModified Spitzy shelf acetabuloplasty is an effective joint-preserving surgery with a wide range of potential indications.Cite this article: Bone Jt Open 2023;4(12):932–941.

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Section: Discussionmentioning

confidence: 99%

The modified Spitzy shelf acetabuloplasty for the dysplastic hip

Oe,

Iida,

Otsuki

et al. 2023

Bone Jt Open

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“…Due to the complicated definition of BHD, treatment remains controversial. Periacetabular osteotomy, the standard treatment for hip dysplasia, which reorients the acetabular osseous coverage for good short-and longterm outcomes [8], is not applicable for BHD, given the invasiveness of the procedure and the associated risk of complications [42]. In recent decades, hip arthroscopy has been an effective treatment option with good outcomes for many hip pathologies [26]; however, its applicability for hip dysplasia is still in dispute due to its reported failure rate and the potential of exacerbating the instability, subsequently resulting in osteoarthritis [29,36].…”

Section: Introductionmentioning

confidence: 99%

Noninterportal capsulotomy of hip arthroscopy showed improved outcomes in borderline hip dysplasia: A retrospective study with minimum 2‐year follow‐up

Liu,

Liang,

Xie

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe present study aimed to evaluate the functional outcomes of hip arthroscopy using a noninterportal capsulotomy technique to address labral tears in patients with borderline hip dysplasia (BHD). Additionally, we also compared these outcomes with those of patients with BHD who underwent the standard repaired interportal capsulotomy (RIPC) arthroscopy.MethodsData from patients with BHD were retrieved from a database of patients who underwent arthroscopic hip surgery with noninterportal capsulotomy or RIPC to treat labral tears between January 2014 and December 2020. Data collected included both pre‐ and postoperative patient‐reported outcomes (PROs).ResultsA total of 58 patients (noninterportal capsulotomy, n = 37; RIPC, n = 21) with a mean age of 30.9 ± 5.6 and 28.6 ± 5.5 years, respectively, met the inclusion criteria. All of the patients underwent a minimal 2‐year follow‐up. The mean lateral centre‐edge angle was 23.3 ± 1.2° in the noninterportal capsulotomy group and 23.7 ± 1.0° in the RIPC group, with no significant difference. The PROs improved from the preoperative to the latest follow‐up, with a p < 0.001. There were no differences between the groups.ConclusionUsing strict patient selection criteria, hip arthroscopy with noninterportal capsulotomy demonstrated significant pre‐ to postoperative improvements in patients with BHD and achieved results comparable to those from hip arthroscopy with RIPC.Level of EvidenceLevel III.

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Komplikationen und deren Behandlung nach PAO

et al. 2023

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Zusammenfassung Hintergrund Die Hüftdysplasie stellt die häufigste Ursache der sekundären Koxarthrose dar. Die periazetabuläre Osteotomie (PAO) nach Ganz ist ein etabliertes Therapieverfahren, welches eine reproduzierbare Korrektur der dreidimensionalen Pathologie erlaubt. Den mittel- und langfristigen guten Behandlungsergebnissen stehen potenzielle Komplikationsrisiken eines invasiven Beckeneingriffes gegenüber. In Anbetracht des vornehmlich jungen Alters der Patient*innen ist eine Kenntnis der möglichen Komplikationen und der daraus resultierenden adäquaten Therapie wichtig. Therapieentwicklung Die kontinuierliche Weiterentwicklung der Operationstechnik und die zunehmende Erfahrung der Operateur*innen – mit dem sich hieraus ergebenden wachsenden Verständnis bezüglich kritischer Operationsschritte – haben zu einer wesentlichen Reduktion schwerwiegender Komplikationen geführt. Um darüber hinaus das Outcome für die Patient*innen zu verbessern, sind neben der Reduktion der Komplikationsrate auch ein besseres Verständnis bezüglich der hüftdysplasieassoziierten Begleitpathologien essenziell.

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Periacetabular osteotomy to treat hip dysplasia: a systematic review of harms and benefits

Cited by 4 publications

References 46 publications

The modified Spitzy shelf acetabuloplasty for the dysplastic hip

The modified Spitzy shelf acetabuloplasty for the dysplastic hip

Noninterportal capsulotomy of hip arthroscopy showed improved outcomes in borderline hip dysplasia: A retrospective study with minimum 2‐year follow‐up

Komplikationen und deren Behandlung nach PAO

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