Bernese periacetabular osteotomy: functional outcomes in patients with untreated intra-articular lesions

Abstract

Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19–31), 96% females. Mean follow-up 7 years (range: 3–16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.

The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy

“…1,4,7,12,18 Still, despite the high incidence of intraarticular pathology (including labral pathology), good outcomes from PAO alone were achieved in this study as well as in others. 6,9,11,21 The major strengths of our study were that our study and control groups were demographically and radiographically similar. For the purposes of our data models, we controlled for age, sex, BMI, and preoperative PROM scores to enhance our ability to match these populations as closely as possible for comparison.…”

The Scientific Evolution of Periacetabular Osteotomy: A Global Review

“…Several studies provided Kaplan–Meier survival analysis of the dysplasic hip after PAO with total hip arthroplasty as an endpoint. These studies were published from nine institutions and represented substance for a recent meta-analysis [ 1 , 22 , 23 , 24 , 25 , 26 ]. In this meta-analysis, the pooled estimates of dysplastic hips of patients who were less than 40 years of age, with an LCE of <25° and limited degenerative changes were calculated.…”

3D MRI of the Hip Joint: Technical Considerations, Advantages, Applications, and Current Perspectives

“…This procedure results in good long-term outcomes including avoidance of total hip arthroplasty at 15 years in up to 87% of patients. [37][38][39] In the event of nonrecognition of underlying dysplasia and attempted cam resection, instability can be exacerbated iatrogenically (►Fig. 10).…”