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Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome

AIMS: Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors...

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Autores principales: Verhaegen, Jeroen, Salih, Saif, Thiagarajah, Shankar, Grammatopoulos, George, Witt, Johan D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2021
Materias:
Hip
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479841/
https://www.ncbi.nlm.nih.gov/pubmed/34543579
http://dx.doi.org/10.1302/2633-1462.29.BJO-2021-0096.R2
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author Verhaegen, Jeroen
Salih, Saif
Thiagarajah, Shankar
Grammatopoulos, George
Witt, Johan D.
author_facet Verhaegen, Jeroen
Salih, Saif
Thiagarajah, Shankar
Grammatopoulos, George
Witt, Johan D.
author_sort Verhaegen, Jeroen
collection PubMed
description AIMS: Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome. METHODS: A single-centre, retrospective cohort study was performed on patients with acetabular retroversion treated with PAO (n = 62 hips). Acetabular retroversion was diagnosed clinically and radiologically (presence of a crossover sign, posterior wall sign, lateral centre-edge angle (LCEA) between 20° and 35°). Outcomes were compared with a control group of patients undergoing PAO for dysplasia (LCEA < 20°; n = 86 hips). Femoral version was recorded. Patient-reported outcome measures (PROMs), complications, and reoperation rates were measured. RESULTS: The mean Non-Arthritic Hip Score (NAHS) preoperatively was 58.6 (SD 16.1) for the dysplastic hips and 52.5 (SD 12.7) for the retroverted hips (p = 0.145). Postoperatively, mean NAHS was 83.0 (SD 16.9) and 76.7 (SD 17.9) for dysplastic and retroverted hips respectively (p = 0.041). Difference between pre- and postoperative NAHS was slightly lower in the retroverted hips (18.3 (SD 22.1)) compared to the dysplastic hips (25.2 (SD 15.2); p = 0.230). At mean 3.5 years’ follow-up (SD 1.9), one hip needed a revision PAO and no hips were converted to total hip arthroplasty (THA) in the retroversion group. In the control group, six hips (7.0%) were revised to THA. No differences in complications (p = 0.106) or in reoperation rate (p = 0.087) were seen. Negative predictors of outcome for patients undergoing surgery for retroversion were female sex, obesity, hypermobility, and severely decreased femoral anteversion. CONCLUSION: A PAO is an effective surgical intervention for acetabular retroversion and produces similar improvements when used to treat dysplasia. Femoral version should be routinely assessed in these patients and when extremely low (< 0°), as an additional procedure to address this abnormality may be necessary. Females with signs of hypermobility should also be consulted of the likely guarded improvement. Cite this article: Bone Jt Open 2021;2(9):757–764.
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spelling pubmed-84798412021-10-14 Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome Verhaegen, Jeroen Salih, Saif Thiagarajah, Shankar Grammatopoulos, George Witt, Johan D. Bone Jt Open Hip AIMS: Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome. METHODS: A single-centre, retrospective cohort study was performed on patients with acetabular retroversion treated with PAO (n = 62 hips). Acetabular retroversion was diagnosed clinically and radiologically (presence of a crossover sign, posterior wall sign, lateral centre-edge angle (LCEA) between 20° and 35°). Outcomes were compared with a control group of patients undergoing PAO for dysplasia (LCEA < 20°; n = 86 hips). Femoral version was recorded. Patient-reported outcome measures (PROMs), complications, and reoperation rates were measured. RESULTS: The mean Non-Arthritic Hip Score (NAHS) preoperatively was 58.6 (SD 16.1) for the dysplastic hips and 52.5 (SD 12.7) for the retroverted hips (p = 0.145). Postoperatively, mean NAHS was 83.0 (SD 16.9) and 76.7 (SD 17.9) for dysplastic and retroverted hips respectively (p = 0.041). Difference between pre- and postoperative NAHS was slightly lower in the retroverted hips (18.3 (SD 22.1)) compared to the dysplastic hips (25.2 (SD 15.2); p = 0.230). At mean 3.5 years’ follow-up (SD 1.9), one hip needed a revision PAO and no hips were converted to total hip arthroplasty (THA) in the retroversion group. In the control group, six hips (7.0%) were revised to THA. No differences in complications (p = 0.106) or in reoperation rate (p = 0.087) were seen. Negative predictors of outcome for patients undergoing surgery for retroversion were female sex, obesity, hypermobility, and severely decreased femoral anteversion. CONCLUSION: A PAO is an effective surgical intervention for acetabular retroversion and produces similar improvements when used to treat dysplasia. Femoral version should be routinely assessed in these patients and when extremely low (< 0°), as an additional procedure to address this abnormality may be necessary. Females with signs of hypermobility should also be consulted of the likely guarded improvement. Cite this article: Bone Jt Open 2021;2(9):757–764. The British Editorial Society of Bone & Joint Surgery 2021-09-20 /pmc/articles/PMC8479841/ /pubmed/34543579 http://dx.doi.org/10.1302/2633-1462.29.BJO-2021-0096.R2 Text en © 2021 Author(s) et al. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Hip
Verhaegen, Jeroen
Salih, Saif
Thiagarajah, Shankar
Grammatopoulos, George
Witt, Johan D.
Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome
title Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome
title_full Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome
title_fullStr Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome
title_full_unstemmed Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome
title_short Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: The role of femoral anteversion on outcome
title_sort is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia?: the role of femoral anteversion on outcome
topic Hip
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479841/
https://www.ncbi.nlm.nih.gov/pubmed/34543579
http://dx.doi.org/10.1302/2633-1462.29.BJO-2021-0096.R2
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