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Published on: September 7, 2022
Patient-Reported Outcomes and Factors Impacting Success of the Periacetabular Osteotomy
Muzammil Akhtar1, Daniel I Razick1, Jimmy Wen2
1Surgery, California Northstate University College of Medicine, Elk Grove, USA.
Insights
Periacetabular osteotomy (PAO) significantly improves hip dysplasia outcomes, with most patients reporting better function. Patient selection is key to success and avoiding complications like total hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
Background:
- Hip dysplasia involves a shallow acetabulum, leading to hip instability and stress.
- Periacetabular osteotomy (PAO) is a surgical correction for hip dysplasia, repositioning the acetabulum.
- This review focuses on outcomes in patients without prior hip dysplasia interventions.
Purpose of the Study:
- To systematically review patient factors impacting periacetabular osteotomy (PAO) outcomes.
- To analyze patient-reported outcomes using the Harris Hip Score (HHS) and WOMAC.
- To assess the efficacy of PAO in patients with no previous hip dysplasia treatment.
Main Methods:
- Systematic review of seven studies on periacetabular osteotomy (PAO).
- Analysis of patient factors: Tönnis OA grade, LCEA, joint congruency, Tönnis angle, and age.
- Evaluation of patient-reported outcomes: Harris Hip Score (HHS) and WOMAC scores.
Main Results:
- Six of seven studies met the minimally important clinical difference (MCID) for patient-reported outcomes.
- Significant improvements observed in mean HHS (68.92 to 89.1) and mHHS (70 to 91) post-PAO.
- WOMAC scores showed a slight decrease (66 to 63), indicating modest improvement.
Conclusions:
- Periacetabular osteotomy (PAO) is effective for hip dysplasia in non-operated patients, improving functional scores.
- Preoperative Tönnis OA grade, LCEA, joint congruency, Tönnis angle, and age influence PAO outcomes.
- Careful patient selection is crucial for PAO success and to prevent early conversion to total hip arthroplasty (THA).
Abstract:
Hip dysplasia is a condition affecting both infants and adults, characterized by a shallow acetabulum that does not sufficiently cover the head of the femur. This leads to instability of the hip and elevated levels of mechanical stress around the acetabular rim. A popular procedure for the correction of hip dysplasia is the periacetabular osteotomy (PAO), in which fluoroscopically guided osteotomies around the pelvis are made to allow for repositioning of the acetabulum to fit properly on the femoral head. This systematic review aims to analyze patient factors that impact outcomes, as well as patient-reported outcomes such as the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients in this review did not undergo any prior intervention for acetabular hip dysplasia, allowing for an unbiased reporting of outcomes from all included studies. Of studies reporting HHS, the mean preoperative HHS was 68.92 and the mean postoperative HHS was 89.1. Of the study that reported mHHS, the mean preoperative mHHS was 70, and the mean postoperative mHHS was 91. Of the studies reporting WOMAC, the mean preoperative WOMAC was 66, and the mean postoperative WOMAC was 63. Key findings of this review are that of the seven included studies, six achieved a minimally important clinical difference (MCID) based on patient-reported outcomes, and factors impacting outcome are preoperative Tönnis osteoarthritis (OA) grade, pre and postoperative lateral-center edge angle (LCEA), preoperative hip joint congruency, postoperative Tönnis angle, and age. In patients with no prior intervention for hip dysplasia, the PAO is a successful procedure with significant improvement in postoperative patient-reported outcomes. Despite the reported success of the PAO, proper patient selection is vital to avoid early conversions to total hip arthroplasty (THA) and prolonged pain. However, further investigation is prompted regarding the long-term survivorship of the PAO in patients with no prior intervention for hip dysplasia.
