20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips

Abstract

Aims Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). Methods A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. Results THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. Conclusion This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767–774.

Joint awareness following periacetabular osteotomy in patients with hip dysplasia

“…Previous studies employed various PROMs to improve the quantification of a patient's experience following PAO; however, there is no consensus on which outcomes should be used. 8,10,[12][13][14][15] Wasko et al 12 analyzed the psychometric properties of hip-specific PROMs and found that the HOOS was most appropriate for patients undergoing PAO. However, HOOS consists of 40 items, hindering its routine use in clinical practice.…”

“…While the long-term effectiveness of PAO in terms of finite endpoints, such as conversion to THA, has been demonstrated, [8][9][10] an accurate assessment of functional capacity and QoL may be more important for young, active patients undergoing PAO. The median FJS-12 of PAO patients in this study was considerably lower than the normative values for FJS-12 in the USA general population: a median FJS-12 score of 87.5 for the total sample and 79.5 for women in their fourth decade.…”

“…Patients. We retrospectively reviewed clinical and radiological data on TOA (Figure 1), 8,23 a type of spherical PAO, for the treatment of symptomatic hip dysplasia from a prospectively collected database at the Department of Orthopaedic Surgery, Faculty of Medicine, Saga University. Between November 1998 and July 2019, 684 patients (882 hips) underwent TOA at our hospital.…”

“…5 Periacetabular osteotomies (PAOs), including Bernese PAO, rotational acetabular osteotomy, and transposition osteotomy of the acetabulum (TOA), have been developed to correct these deformities and improve the mechanical environment of the hip in an effort to delay or prevent OA progression. [6][7][8] Although the long-term effectiveness of PAO in terms of finite endpoints, such as conversion to total hip arthroplasty (THA), has been demonstrated, [8][9][10] improvements in the functional capacity and quality of life (QoL) may be of greater importance for young, active patients undergoing PAO. Consequently, determining suitable outcomes to measure accurately a patient's subjective symptom status remains a major challenge.…”

“…However, validated PROMs for PAO are scarce, and there is no consensus on which outcome should be used. 8,10,[12][13][14][15] Most hip-specific PROMs, including the Hip disability and Osteoarthritis Outcome Score (HOOS), 16 are designed primarily for either OA or THA populations and have shown large ceiling effects when administered to PAO patients. 17 Contrastingly, PROMs developed for younger, active patients with hip disorders, such as the International Hip Outcome Tool (iHOT), have been widely used in hip preservation procedures, 13,18 but not validated in OA, PAO, or THA populations, raising concerns about their generalizability.…”