Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Abstract

Background Acetabular retroversion can cause impaction-type femoroacetabular impingement leading to hip pain and osteoarthritis. It can be treated by anteverting periacetabular osteotomy (PAO) or acetabular rim trimming with refixation of the labrum. There is increasing evidence that acetabular retroversion is a rotational abnormality of the entire hemipelvis and not a focal overgrowth of the anterior acetabular wall, which favors an anteverting PAO. However, it is unknown if this larger procedure would be beneficial in terms of survivorship and Merle d'Aubigné scores in a midterm followup compared with rim trimming. Questions/purposes We asked if anteverting PAO results in increased survivorship of the hip compared with rim trimming through a surgical hip dislocation in patients with symptomatic acetabular retroversion. Methods We performed a retrospective, comparative study evaluating the midterm survivorship of two matched patient groups with symptomatic acetabular retroversion undergoing either anteverting PAO or acetabular rim trimming through a surgical hip dislocation. Acetabular retroversion was defined by a concomitantly present positive crossover, posterior wall, and ischial spine sign. A total of 279 hips underwent a surgical intervention for acetabular retroversion at our center between 1997 and 2012 (166 periacetabular osteotomies, 113 rim trimmings through surgical hip dislocation). A total of 99 patients (60%) were excluded from the PAO group and 56 patients (50%) from the rim trimming group because they had any of several prespecified conditions (eg, dysplasia . A minimum followup of 2 years was required for this study. Failures were included at any time. The median followup for the anteverting PAO group was 9.5 years (range, 2-17.4 years) and 6.8 years (range, 2.2-10.5 years) for the rim trimming group (p \ 0.001). Kaplan-Meier survivorship analysis was performed using the following endpoints at 5 and 10 years: THA, radiographic One author (MT) has received funding from the Swiss National Science Foundation (SNSF). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Femoroacetabular Impingement: What the Surgeon Wants to Know

“…[93][94][95] To address this deformity, an acetabular reorientation procedure is the rational option. According to Zurmühle et al, 96 it yields better long-term results than isolated rim trimming (►Fig. 8).…”

The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

“…42 A retrospective study proved that anteverting PAO was superior to hip surgical hip dislocation with rim trimming after ten-year follow-up (79.1% vs 23.0%, p = 0.0002). 45 …”

Conventional and Arthrographic Magnetic Resonance Techniques for Hip Evaluation: What the Radiologist Should Know

“…61,62 Depending on the severity of the deformity, an impingement-free range of motion can be restored with acetabular rim trimming or acetabular reorientation. 63,64 Until recently the assessment of FAI mainly focused on proximal femoral head morphology, acetabular coverage and version. However, it was shown that femoral torsion considerably affects the impingement-free range of motion 65,66 and that severely abnormal femoral torsion may be present in one of six hips undergoing an MRI of the hip.…”