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Increased Risk of Stress Fractures Following Second-Side Periacetabular Osteotomy: A Retrospective Cohort Study.
Bernard H van Duren1, Mohammad H Amer2, Jack Stewart3
1Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Trust, Ashington, UK; Nottingham Elective Orthopaedic Services, Nottingham University Hospitals Trust, Nottingham, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Patients undergoing a second periacetabular osteotomy (PAO) face a 25% risk of stress fracture. This risk significantly increases to nearly 80% if a stress fracture occurred after the first PAO procedure.
Area of Science:
- Orthopedic Surgery
- Hip Preservation Surgery
- Radiology
Background:
- Postoperative stress fractures after periacetabular osteotomy (PAO) can delay healing and lead to nonunion.
- Bilateral PAO is performed for acetabular dysplasia or retroversion.
- Understanding stress fracture incidence is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence of stress fractures following PAO.
- To assess the risk of a second-side stress fracture after a first-side PAO.
- To identify risk factors for stress fractures in bilateral PAO patients.
Main Methods:
- Retrospective review of 112 patients (224 procedures) undergoing bilateral PAO (2013-2023).
- Analysis of demographic data, anatomical measurements, and postoperative radiographs.
- Identification of stress fractures on initial and second-side procedures.
Main Results:
- First-side PAO stress fracture incidence was 11.6% (13/112).
- Second-side PAO stress fracture incidence was 25% (28/112).
- Patients with a first-side stress fracture had a 79.6% risk of a second-side stress fracture (10/13).
Conclusions:
- A 25% risk of stress fracture exists for the second side PAO.
- Previous stress fracture significantly elevates the risk for the contralateral side.
- Surgeons should consider increased risks and potential modifiable factors before second PAO.
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