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Risk factors for delayed pubic union after eccentric rotational acetabular osteotomy
Shinya Tanaka1, Yusuke Osawa2, Yasuhiko Takegami1
1Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
International Orthopaedics
|October 21, 2025
Summary
Older age, a medial pubic osteotomy site, and insufficient femoral head medialization are key risk factors for delayed union after eccentric rotational acetabular osteotomy (ERAO). These factors increase stress fracture risk but do not impact two-year hip function.
Area of Science:
- Orthopedic surgery
- Hip reconstruction
- Acetabular dysplasia treatment
Background:
- Eccentric rotational acetabular osteotomy (ERAO) effectively treats acetabular dysplasia.
- Delayed union of the superior pubic ramus is a known complication of ERAO.
- Identifying risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify independent risk factors for delayed pubic union following ERAO.
- To evaluate the clinical impact of delayed pubic union.
- To assess the association between surgical parameters and pubic union complications.
Main Methods:
- Retrospective analysis of 101 patients undergoing ERAO (2014-2022).
- Patients grouped by one-year pubic union status: union (n=78) vs. delayed union (n=23).
- Comparison of demographics, pre/postoperative radiographic parameters, and clinical outcomes.
Main Results:
- Older age (OR 1.07), medial pubic osteotomy site (OR 1.28), and insufficient femoral head medialization (OR 1.40) were independent risk factors for delayed union.
- A pubic osteotomy site >12.0 mm medial to the iliopectineal eminence predicted delayed union.
- Delayed union group had higher rates of inferior pubic ramus stress fractures (17.4% vs. 1.3%, p=0.009).
Conclusions:
- Older age, medial pubic osteotomy, and insufficient femoral head medialization are significant risk factors for delayed pubic union post-ERAO.
- These factors increase the risk of inferior pubic ramus stress fractures.
- Accurate osteotomy placement and avoiding femoral head lateralization are essential for successful ERAO outcomes.
