What level of pain reduction can be expected up to two years after periacetabular osteotomy? A prospective cohort study of 146 patients

Abstract

Periacetabular osteotomy (PAO) corrects underlying anatomical anomalies, reduces pain and may postpone or even prevent osteoarthritis onset in patients with symptomatic acetabular dysplasia. Current evidence is based on immediate post-operative pain levels, but knowledge on pain levels in the period after PAO is scarce, and the association between pain score and acetabular angles at PAO is unknown. This study had two aims. First, we studied pain level and patient-reported outcome scores pre- and postoperatively; second, we analysed the association between acetabular angles and pain level. From our database, 426 patients operated from June 2012 to November 2015 were analysed; 127 were excluded. Patients were invited to complete standardized questionnaires preoperatively and postoperatively at 6 and 24 months. Pain was measured using visual analogue scale (VAS). Multiple regression analysis was used to investigate the association between change in centre edge (CE) and acetabular index (AI) angle and pre/postoperative pain levels. Mean (standard deviation, SD) VAS pain at rest before surgery and at the 6- and 24-month follow-up were 35 (24), 14 (20) and 14 (19), respectively. Mean (SD) VAS pain at activity were 69 (22), 41 (29) and 41 (30), respectively. Both VAS pain at rest and at activity fell from the preoperative level to 6 months post-surgery with no further change at 24 months. Patients reported significant improvement in outcomes after 6 months and no further change at the 24-month follow-up. There was no significant association between change in CE/AI angles and VAS pain, either during rest or activity.

Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes

“…In reviewing the literature, we observed that PROs were worse before PAO when compared to scores after PAO [ 3 , 7 , 22 , 23 , 28 , 31–39 ]. Before PAO, participants reported higher pain [ 3 , 23 , 28 , 32 , 33 , 35 , 37–40 ], worse hip-related function [ 3 , 7 , 29 , 31–47 ], lower quality of life [ 3 , 28 , 29 , 34 , 35 , 37 , 38 , 40 , 42 ], worse laboratory-based functional performance (such as walking speed) [ 32 ] and a significant reduction in PA levels, both through the use of patient-reported [ 3 , 22 , 23 , 28 , 34 , 35 , 38 , 39 , 43 , 47 , 48 ] or device-measured [ 23 , 28 ] PA.…”

“…In the studies referenced above, hip-related pain, function and quality of life were measured using common hip-related questionnaires that have been shown to be reliable and valid in individuals with hip pathology, including (i) the modified Harris Hip Score or the standard Harris Hip Score (mHHS/HHS; n = 15) [ 3 , 7 , 29 , 31–33 , 35 , 36 , 38–41 , 43 , 44 , 47 ], (ii) the Hip Disability and Osteoarthritis Outcomes Score (HOOS; n = 10) [ 3 , 29 , 32 , 35 , 37 , 38 , 40 , 42 , 43 , 46 ], (iii) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; n = 7) [ 33 , 35 , 38 , 39 , 44 , 46 , 47 ], (iv) the Copenhagen Hip and Groin Outcome Score (HAGOS; n = 3) [ 23 , 28 , 34 ], (v) the International Hip Outcome Tool (iHOT-12; n = 1) [ 32 ], (vi) the Patient-Reported Outcomes Measurement Information System (PROMIS; n = 1) [ 32 ], (vii) The Short Form 36 Health Survey Questionnaire (SF-36; n = 2) [ 33 , 42 ], (viii) the Numeric Pain Rating scale (NPRS; n = 1) [ 34 ], (ix) the Visual Analogue Scale (VAS; n = 1) [ 32 ], and the Non-Arthritic Hip Score (NAHS; n = 1) [ 45 ].…”

“…Of the overall included studies ( n = 23), 14 studies evaluated pain intensity in persons with symptomatic AD before and after PAO [ 3 , 23 , 28 , 29 , 32 , 33 , 35 , 37–40 , 42 , 44 , 47 ], using several PROs, included the HOOS ( n = 8) [ 3 , 32 , 35 , 37 , 38 , 40 , 42 , 48 ], WOMAC ( n = 6) [ 33 , 35 , 38 , 39 , 44 , 47 ], HAGOS ( n = 2) [ 28 , 34 ], VAS scale ( n = 1) [ 32 ] and NPRS ( n = 1) [ 34 ]. Average scores of pain intensity before and after PAO in persons with symptomatic AD are provided in Table I .…”

“…Of the 14 studies that evaluated pain intensity in persons with symptomatic AD, 6 studies used prospective study designs monitoring pain changes over 4 months to 2 years following PAO (total combined sample = 857) [ 3 , 28 , 32–35 ]. Eight studies used retrospective study designs reviewing reports that evaluated pain intensity after 2 years [ 37 , 40 , 42 , 44 , 48 ], 3 years [ 38 ], 5 years [ 39 ] and 6 years [ 47 ] following PAO, respectively (total combined sample = 625). Across studies, there were significant improvements in pain intensity among persons with symptomatic AD up to 6 years following PAO (all studies reported statistically significant improvements; P < 0.05; total combined sample = 1482) [ 3 , 23 , 28 , 29 , 32 , 33 , 35 , 37–40 , 42 , 44 , 47 ].…”

“…Of the overall included studies ( n = 23), 19 evaluated hip-related function in persons with symptomatic AD before and after PAO [ 3 , 7 , 31–45 , 47 , 48 ], using several PROs, including the mHHS/HHS ( n = 15) [ 3 , 7 , 29 , 31–33 , 35 , 36 , 38–41 , 43 , 44 , 47 ], HOOS ( n = 7) [ 3 , 29 , 32 , 35 , 37 , 38 , 42 ], WOMAC ( n = 4) [ 33 , 38 , 39 , 44 ], iHOT-12 and the PROMIS (physical function subscale; n = 1) [ 32 ], HAGOS ( n = 1) [ 34 ], and NAHS (1) [ 45 ]. Average scores on hip-related function before and after PAO in persons with symptomatic AD are provided in Table I .…”