Treatment of Adolescents with a Periacetabular Osteotomy After Previous Pelvic Surgery

Rocha, Adriana De La; Sucato, Daniel J.; Tulchin, Kirsten; Podeszwa, David A.

doi:10.1007/s11999-012-2298-3

Cited by 17 publications

(25 citation statements)

References 39 publications

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“…Czubak et al [8] found that in their cohort of 43 hips, the mean ACEA improved from À10°to 35°. De La Rocha et al [10] reported a change in LCEA from 1.9°to 26.2°, Tönnis angle from 25.3°to 10.1°, and ACEA from À3°to 20.1°. Mayo et al [22] calculated an increased LCEA from 5°to 29°, improved AI of 24°to 6°, and more anterior coverage with an ACEA of 3°to 24°.…”

Section: Discussionmentioning

confidence: 99%

“…Sparse data currently exist regarding revision PAO surgery. De La Rocha et al [10] demonstrated gait abnormalities at 1-year followup (mean, 1.1 years; range, 0.9-1.9 years) in 13 patients who had 15 revision proceduresowing to decreased hip flexion and abduction strength compared with a first-time PAO cohort. Czubak and colleagues [8] noted improvements in pain but decreased hip flexion in 10 adult patients who underwent PAO years after a prior Chiari, shelf, or Dega osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…The radiographic correction achieved was smaller in patients who had undergone prior pelvic osteotomy surgery than in patients undergoing PAO without prior pelvic surgery. With revision PAOs, the mean correction attained was 19°for LCEA (p \ 0.001, SD 10°; 95% CI, 14-24), 13°for ACEA (p = 0.014, SD 12°; 95% CI, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and À12°for AI (p \ 0.001, SD 9°; 95% CI, À20 to À15) ( Table 3). In comparison, the mean correction attained in the primary cohort was 22°in LCEA (p \ 0.001, SD 10°; 95% CI, 20-26), À17°for AI (p \ 0.001, SD 6°; 95% CI, À16 to À6), and 24°for ACEA (p \ 0.001, SD 12°; 95% CI, [19][20][21][22][23][24][25][26][27][28][29].…”

Section: Methodsmentioning

confidence: 99%

“…The outcomes of the PAO surgery after prior pelvis and/ or femoral osteotomy or arthroscopic procedures have been reported in small case series [8,10,12,25]. When considering only prior pelvic reconstruction, even less information exists to demonstrate the efficacy of the PAO.…”

Section: Introductionmentioning

confidence: 99%

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

Stambough

Clohisy

Baca

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Stambough

Clohisy

Baca

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Encouraging early functional and radiographic outcomes have been reported among adolescents. [7][8][9] The rate of complications after PAO has been related to the technical complexity and surgeon's learning curve. 10,11 Specifically in adolescents, major complications have been associated with longer surgical times, greater blood loss, and concomitant femoral osteotomy.…”

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confidence: 99%