Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH.
- Albers CE Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Steppacher SD
- Ganz R
- Tannast M
- Siebenrock KA
- 2013-01-29
Published in:
- Clinical orthopaedics and related research. - 2013
Acetabulum
Adolescent
Adult
Arthroplasty, Replacement, Hip
Biomechanical Phenomena
Child
Disease Progression
Female
Femoracetabular Impingement
Femur Head
Hip Dislocation, Congenital
Hip Joint
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Osteotomy
Proportional Hazards Models
Radiography
Range of Motion, Articular
Recovery of Function
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Failure
Young Adult
English
BACKGROUND
Although periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) provides conceptual advantages compared with other osteotomies and reportedly is associated with joint survivorship of 60% at 20 years, the beneficial effect of proper acetabular reorientation with concomitant arthrotomy and creation of femoral head-neck offset on 10-year hip survivorship remains unclear.
QUESTIONS/PURPOSES
We asked the following questions: (1) Does the 10-year survivorship of the hip after PAO improve with proper acetabular reorientation and a spherical femoral head; (2) does the Merle d'Aubigné-Postel score improve; (3) can the progression of osteoarthritis (OA) be slowed; and (4) what factors predict conversion to THA, progression of OA, or a Merle d'Aubigné-Postel score less than 15 points?
METHODS
We retrospectively reviewed 147 patients who underwent 165 PAOs for DDH with two matched groups: Group I (proper reorientation and spherical femoral head) and Group II (improper reorientation and aspherical femoral head). We compared the Kaplan-Meier survivorship, Merle d'Aubigné-Postel scores, and progression of OA in both groups. A Cox regression analysis (end points: THA, OA progression, or Merle d'Aubigné-Postel score less than 15) was performed to detect factors predicting failure. The minimum followup was 10 years (median, 11 years; range, 10-14 years).
RESULTS
An increased survivorship was found in Group I. The Merle d'Aubigné-Postel score did not differ. Progression of OA in Group I was slower than in Group II. Factors predicting failure included greater age, lower preoperative Merle d'Aubigné-Postel score, and the presence of a Trendelenburg sign, aspherical head, OA, subluxation, postoperative acetabular retroversion, excessive acetabular anteversion, and undercoverage.
CONCLUSIONS
Proper acetabular reorientation and the creation of a spherical femoral head improve long-term survivorship and decelerate OA progression in patients with DDH.
Although periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) provides conceptual advantages compared with other osteotomies and reportedly is associated with joint survivorship of 60% at 20 years, the beneficial effect of proper acetabular reorientation with concomitant arthrotomy and creation of femoral head-neck offset on 10-year hip survivorship remains unclear.
QUESTIONS/PURPOSES
We asked the following questions: (1) Does the 10-year survivorship of the hip after PAO improve with proper acetabular reorientation and a spherical femoral head; (2) does the Merle d'Aubigné-Postel score improve; (3) can the progression of osteoarthritis (OA) be slowed; and (4) what factors predict conversion to THA, progression of OA, or a Merle d'Aubigné-Postel score less than 15 points?
METHODS
We retrospectively reviewed 147 patients who underwent 165 PAOs for DDH with two matched groups: Group I (proper reorientation and spherical femoral head) and Group II (improper reorientation and aspherical femoral head). We compared the Kaplan-Meier survivorship, Merle d'Aubigné-Postel scores, and progression of OA in both groups. A Cox regression analysis (end points: THA, OA progression, or Merle d'Aubigné-Postel score less than 15) was performed to detect factors predicting failure. The minimum followup was 10 years (median, 11 years; range, 10-14 years).
RESULTS
An increased survivorship was found in Group I. The Merle d'Aubigné-Postel score did not differ. Progression of OA in Group I was slower than in Group II. Factors predicting failure included greater age, lower preoperative Merle d'Aubigné-Postel score, and the presence of a Trendelenburg sign, aspherical head, OA, subluxation, postoperative acetabular retroversion, excessive acetabular anteversion, and undercoverage.
CONCLUSIONS
Proper acetabular reorientation and the creation of a spherical femoral head improve long-term survivorship and decelerate OA progression in patients with DDH.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1007/s11999-013-2799-8
- PMID 23354462
- Persistent URL
- https://sonar.ch/global/documents/79947
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