A qualitative study of the impact of a periacetabular osteotomy on patients’ lives

Abstract

Aims The aim of this study was to understand the experience of mature patients who undergo a periacetabular osteotomy (PAO), a major hip-preserving surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to improve our understanding of how the operation affected the lives of patients and their families, with a long-term goal of improving their experience. Methods We used a phenomenological approach with in-depth, semi-structured interviews to investigate the experience of seven female patients, aged between 25 and 40 years, who underwent a PAO. A modified homogeneity sampling approach coupled with criterion sampling was used. Inclusion criteria involved having at least one child at home and being in a committed relationship with a spouse or partner. Results Analysis of interview transcripts revealed five major themes: feelings of frustration before having a treatment plan; fear of the operation; the importance of understanding the procedure in order to feel in control of their care; feelings of helplessness, dependence, and depression during recovery; and the need for support during recovery. Conclusion Our findings suggest that both the physical and psychosocial burdens of undergoing a PAO are great, with a major impact on the patient and their family. Many important issues lie outside the scope of what healthcare teams currently address. Cite this article: Bone Joint J 2022;104-B(7):781–785.

Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia

“…These issues may be further improved using new minimally invasive approaches. 64,65 Our results demonstrated that although there is an increased risk of associated morbidity and perioperative complications, and a longer rehabilitation, 61 PAO can achieve great PROMs and good activity levels even in BHD, in contrast to HA.…”

“…The aspect of associated morbidity should be carefully considered when choosing to perform PAO. 61 It ranges from psychosocial burden from long rehabilitation to under-recognized debilitating stress fractures. 62 Unlike HA, which has an overall complication rate of 3% in a systematic review including 26,000 cases, PAO has been associated with a 7% complication rate, mostly due to wound problems and higher rates of nerve injuries.…”

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.…”

“…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.…”

75 years young

“…We must never forget the great value of our interventions in trauma or orthopaedics. [25][26][27][28][29][30] Trauma and orthopaedic surgeons restore quality of life and that, in turn, improves mobility and almost certainly contributes to longevity. This contribution is often underestimated.…”