0
Scientific Articles   |    
Medium-Term Outcome of Periacetabular Osteotomy and Predictors of Conversion to Total Hip Replacement
Anders Troelsen, MD, PhD1; Brian Elmengaard, MD, PhD1; Kjeld Søballe, MD, DMSc1
1 Orthopaedic Research Unit, University Hospital of Aarhus, Buildings 7B (A.T. and B.E.) and 1B (K.S.), Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark. E-mail address for A. Troelsen: a_troelsen@hotmail.com. E-mail address for B. Elmengaard: brianelm@dadlnet.dk. E-mail address for K. Søballe: kjeld@soballe.com
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Danish Rheumatism Association. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).
Investigation performed at the Orthopaedic Research Unit, University Hospital of Aarhus, Aarhus, Denmark

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Sep 01;91(9):2169-2179. doi: 10.2106/JBJS.H.00994
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Little is known about medium or long-term results of periacetabular osteotomy and which factors predict a poor outcome in terms of conversion to total hip replacement. The aims of this study were to assess the medium-term outcome following periacetabular osteotomy and to analyze what radiographic and patient-related factors predict a poor outcome.

Methods: One hundred and sixteen periacetabular osteotomies performed by the senior author from December 1998 to December 2002 were eligible for inclusion. Data were assessed through database inquiry and evaluation of radiographic material. The mean duration of follow-up was 6.8 years. At the time of follow-up, we conducted an interview, performed clinical and radiographic examinations, and asked the patients to complete the Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36 questionnaires. We performed a Kaplan-Meier survival analysis, and we used a Cox proportional hazards model to identify factors predicting a poor outcome.

Results: With conversion to total hip replacement as the end point, the Kaplan-Meier analysis showed a hip survival rate of 81.6% (95% confidence interval, 69.7% to 89.3%) at 9.2 years. At the time of follow-up, the median physical component score on the Short Form-36 was 48.31, the median mental component score on the Short Form-36 was 57.95, and the median Western Ontario and McMaster Universities Osteoarthritis Index total score was 84.44. The median pain score on the visual analog scale was 0 at rest and 1 after fifteen minutes of normal walking. When adjusting for preoperative osteoarthritis, we identified seven factors predicting conversion to total hip replacement. Preoperative predictive factors were severe dysplasia on conventional radiographs and computed tomographic scans, reduced acetabular anteversion angle on computed tomographic scans, and the presence of an os acetabuli (calcification of a detached labrum). Predictive factors identified on the immediate postoperative radiographs were a small width of the acetabular sclerotic zone and excessive lateral and proximal dislocation.

Conclusions: Periacetabular osteotomy can be performed with a good outcome at medium-term follow-up, suggesting that it may be applied by experienced surgeons with satisfactory results. To further improve the outcome, focus should be on the potential negative influence of parameters that are easily assessed, such as the preoperative grade of osteoarthritis, the presence of an os acetabuli, and severe acetabular dysplasia.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    01/22/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center