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Clinical and Radiologic Outcomes After Periacetabular Osteotomy for Dysplastic Hips of Adolescents With Hypermobility
Camille Sullivan1, Lei Zhao, Molly Uchtman
1From the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Sullivan, Zhao, Uchtman, McCarthy, and Whitlock), the Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH (Sullivan, Zhao, Uchtman, McCarthy, and Whitlock), the Department of Orthopaedic Surgery, University of California, San Francisco, CA (Sullivan), the Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH (Whitlock), and the Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA (Whitlock).
Background:
Periacetabular osteotomy (PAO) is a common procedure for the treatment of symptomatic acetabular dysplasia in adolescent patients. Despite concerns regarding surgical outcomes and complications in patients with hypermobility spectrum disorders (HSD), the outcomes of PAO in such patients are not well documented.
Methods:
We conducted a retrospective cohort review of patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Radiographic parameters including the lateral center edge angle of Wiberg (LCEA), medial center edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI), and Tönnis angle were measured. Patient-reported outcomes (PROs) were also collected.
Results:
The mean duration of follow-up of non-HSD and HSD patients was 2.86 ± 0.73 years and 3.00 ± 1.11 years, respectively. No significant differences were found in mean age ( P = 0.289), sex, body mass index ( P = 0.125), laterality ( P = 0.192), or the duration of follow-up ( P = 0.636). Postoperatively, LCEA and AWI in patients with HSD were higher than those in non-HSD patients ( P = 0.002, P = 0.007, respectively). No notable differences were observed in Modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool, Hip Dysfunction and Osteoarthritis Outcome Score, or mean changes in PROs between the non-HSD and HSD groups at preoperative, 1-year postoperative, and most recent follow-up timepoints. However, patient-reported satisfaction with surgery in the HSD group (9.39 ± 1.04) was significantly higher than the non-HSD group (8.35 ± 1.95; P = 0.047).
Conclusion:
Patients with HSD exhibited similar outcomes to patients without HSD after PAO for symptomatic acetabular dysplasia. Postoperative AWI and LCEA were markedly greater in patients with HSD consistent with our technical bias toward increased correction in such hips, suggesting greater anterolateral coverage of the femoral head after PAO may be a promising strategy to achieve improved outcomes in patients with HSD.
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