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Revision periacetabular osteotomy enhances joint function and activity level after failure of redirectional pelvic
Maximilian Fischer1, Andreas Nitsch1, Jens Goronzy1
1Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
Aims:
There is a paucity in the literature regarding functional outcomes of revision periacetabular osteotomy (R-PAO) after failure of previous redirectional pelvic osteotomy in a mature skeleton. This study aimed to compare the surgical and patient-reported outcome measures (PROM) between R-PAO and primary PAO.
Methods:
Patients undergoing R-PAO (n = 13) and primary PAO (n = 39) were matched in a 1:3 ratio for age, sex, and surgical date with a minimum follow-up of one year. PROM assessment included scores for pain, joint function (Modified Harris Hip Score -mHHS; International Hip outcome tool-12 -iHOT12), and activity level (University of California Los Angeles activity scale -UCLA). Postoperative outcomes were compared between the groups using independent-samples t-tests and Mann-Whitney U test. Multivariable linear regression was used to identify predictors of postoperative outcome improvement.
Results:
Patients undergoing R-PAO had significantly worse preoperative joint function (mHHS 34.91 to 57.28, p < 0.001; iHot-12 33.17 to 46.22, p = 0.005) and activity level (UCLA 4.38 to 6.34, p = 0.004) compared to primary PAO. While achieving similar functional improvement (Δpre - post, p > 0.05) comparing both groups, postoperative mHHS (70.21 to 86.81, p = 0.002) and pain score (3.46 to 1.92, p = 0.010) remained significantly worse after R-PAO. Multivariable linear regression analysis revealed that preserved preoperative joint function (iHot-12 ß = 0.795, p < 0.001; mHHS ß = 0.696, p < 0.001) and activity level (UCLA ß = 0.360, p < 0.001), a lower BMI (iHot-12 ß = -2.011, p = 0.002; UCLA ß = -0.120, p = 0.041), and a sufficient postoperative anterior wall coverage (iHot-12 ß = 0.849, p < 0.001) are predictors of improved postoperative outcomes in both R-PAO and primary PAO.
Conclusion:
The failure of hip-preserving pelvic osteotomies in skeletally mature patients results in a substantial symptom burden and functional impairment. R-PAO represents a considerable treatment strategy that preserves the native hip joint and function, but postoperative outcomes after R-PAO remain inferior to those of primary PAO, due to the worse preoperative joint function.
