Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia

• Published in: Journal of bone and joint surgery. British volume Vol. 93; no. 11; pp. 1449 - 1456
• Main Authors: FUJII, M, NAKASHIMA, Y, NOGUCHI, Y, YAMAMOTO, T, MAWATARI, T, MOTOMURA, G, IWAMOTO, Y
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.11.2011
• Subjects: Acetabulum - surgery; Adolescent; Adult; Arthroscopy; Biological and medical sciences; Cartilage, Articular - pathology; Disease Progression; Diseases of the osteoarticular system; Female; Femur Head - pathology; Hip Dislocation, Congenital - complications; Hip Dislocation, Congenital - diagnostic imaging; Hip Dislocation, Congenital - pathology; Hip Dislocation, Congenital - surgery; Humans; Male; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Middle Aged; Orthopedic surgery; Osteoarthritis, Hip - diagnostic imaging; Osteoarthritis, Hip - etiology; Osteoarthritis, Hip - prevention & control; Osteotomy - methods; Prognosis; Radiography; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Young Adult; Human; Symptomatology; Orthopedic surgery; Prognosis; Treatment; Hip dysplasia; Malformation; Osteotomy; Diseases of the osteoarticular system; Lesion
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.93B11.27314

In order to clarify how intra-articular lesions influence the survival of a periacetabular osteotomy in patients with dysplasia of the hip, we performed an observational study of 121 patients (121 hips) who underwent a transposition osteotomy of the acetabulum combined with an arthroscopy. Their mean age was 40.2 years (13 to 64) and the mean follow-up was 9.9 years (2 to 18). Labral and cartilage degeneration tended to originate from the anterosuperior part of the acetabulum, followed by the femoral side. In all, eight hips (6.6%) had post-operative progression to Kellgren-Lawrence grade 4 changes, and these hips were associated with the following factors: moderate osteoarthritis, decreased width of the joint space, joint incongruity, and advanced intra-articular lesions (subchondral bone exposure in the cartilage and a full-thickness labral tear). Multivariate analysis indicated subchondral bone exposure on the femoral head as an independent risk factor for progression of osteoarthritis (p = 0.003). In hips with early stage osteoarthritis, femoral subchondral bone exposure was a risk factor for progression of the grade of osteoarthritis. Although the outcome of transposition osteotomy of the acetabulum was satisfactory, post-operative progression of osteoarthritis occurred at a high rate in hips with advanced intra-articular lesions, particularly in those where the degenerative process had reached the point of femoral subchondral bone exposure.