PMID- 36651889
OWN - NLM
STAT- MEDLINE
DCOM- 20230120
LR  - 20230314
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 105
IP  - 2
DP  - 2023 Jan 18
TI  - Outcomes of Periacetabular Osteotomy for Borderline Acetabular Dysplasia.
PG  - 137-144
LID - 10.2106/JBJS.22.00491 [doi]
AB  - BACKGROUND: The optimal surgical treatment (hip arthroscopy compared with 
      periacetabular osteotomy [PAO]) for borderline acetabular dysplasia (lateral 
      center-edge angle [LCEA], 18 degrees  to 25 degrees ) remains a topic of debate. To date, the 
      literature has focused primarily on arthroscopy outcomes, with only a few small 
      reports on PAO outcomes. The purpose of this study was to define PAO outcomes in 
      a large cohort of borderline hips. In a secondary analysis, we assessed the 
      effect of prior failed arthroscopy, concurrent hip arthroscopy, and concurrent 
      femoral osteoplasty on PAO outcomes in this cohort. METHODS: A prospective 
      database was retrospectively reviewed for patients who underwent PAO for 
      symptomatic instability in the setting of borderline dysplasia (LCEA, 18 degrees  to 
      25 degrees ). Of the 232 identified hips, 186 (80.2%) were assessed at a mean follow-up 
      of 3.3 +/- 2.0 years postoperatively. The mean patient age was 25.2 +/- 8.5 years 
      (range, 14 to 45 years), and 88.2% were female. Thirty hips (16.1%) had undergone 
      a failed prior arthroscopy. Arthroscopy was performed concurrently with the PAO 
      in 130 hips (69.9%), and femoral osteoplasty was performed concurrently in 120 
      hips (64.5%). The modified Harris hip score (mHHS) was assessed relative to the 
      minimal clinically important difference (MCID) of 8 and patient acceptable 
      symptom state (PASS) of 74. Clinical failure was defined as a reoperation for 
      persistent symptoms or a failure to achieve either the mHHS MCID or PASS. 
      RESULTS: Of the 156 hips undergoing a primary surgical procedure, clinical 
      success was achieved in 148 hips (94.9% [95% confidence interval (CI), 90.2% to 
      97.4%]). Two hips (1.3% [95% CI, 0.4% to 4.6%]) underwent reoperation (hip 
      arthroscopy) for persistent symptoms and an additional 6 hips (3.8% [95% CI, 1.8% 
      to 8.1%]) failed to achieve the mHHS MCID or PASS, for a clinical failure rate of 
      5.1% (95% CI, 2.6% to 9.8%); 8.8% reported dissatisfaction with the surgical 
      procedure. Clinical failure was more frequent among the 30 hips (23.3% [95% CI, 
      11.8% to 40.9%]; p = 0.001) that had undergone a prior failed arthroscopy. There 
      were no outcome differences between hips that had or had not undergone concurrent 
      hip arthroscopy or femoral osteoplasty. CONCLUSIONS: This study demonstrates 
      excellent early outcomes of PAO for borderline acetabular dysplasia, with 
      significant clinical improvement in 94.9% of patients undergoing a primary 
      surgical procedure; 91.2% were satisfied with the surgical procedure. LEVEL OF 
      EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete 
      description of levels of evidence.
CI  - Copyright (c) 2022 by The Journal of Bone and Joint Surgery, Incorporated.
FAU - Nepple, Jeffrey J
AU  - Nepple JJ
AUID- ORCID: 0000-0002-7582-1415
AD  - Department of Orthopaedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Parilla, Frank W
AU  - Parilla FW
AUID- ORCID: 0000-0002-7462-7362
FAU - Pashos, Gail E
AU  - Pashos GE
AUID- ORCID: 0000-0003-3549-4998
FAU - Clohisy, John C
AU  - Clohisy JC
AUID- ORCID: 0000-0001-7040-616
LA  - eng
PT  - Journal Article
DEP - 20221129
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - IM
CIN - J Bone Joint Surg Am. 2023 Jan 18;105(2):e6. PMID: 36651893
MH  - Humans
MH  - Female
MH  - Adolescent
MH  - Young Adult
MH  - Adult
MH  - Middle Aged
MH  - Male
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Hip Dislocation/surgery
MH  - *Hip Dislocation, Congenital/surgery
MH  - Osteotomy/methods
MH  - Arthroscopy/methods
MH  - Hip Joint/surgery
MH  - Acetabulum/surgery
COIS- Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided 
      with the online version of the article (http://links.lww.com/JBJS/H332).
EDAT- 2023/01/19 06:00
MHDA- 2023/01/21 06:00
CRDT- 2023/01/18 10:42
PHST- 2023/01/18 10:42 [entrez]
PHST- 2023/01/19 06:00 [pubmed]
PHST- 2023/01/21 06:00 [medline]
AID - 00004623-202301180-00006 [pii]
AID - 10.2106/JBJS.22.00491 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2023 Jan 18;105(2):137-144. doi: 10.2106/JBJS.22.00491. 
      Epub 2022 Nov 29.