Abstract
Introduction
Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose of this review was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO.
Methods
From June 2012 to September 2019, 272 Rectus Sparing PAOs were performed and followed for a minimum of one year (mean 4.6 years). The average age was 24 (range 14–44) and 87% were female. The average BMI was 25 and average length of hospital stay was 2.9 days. Patients were evaluated at last follow-up with PROMIS PF-CAT, pain and mental health scores. Clinical records were reviewed for complications or subsequent surgery. Pre and post-operative radiographs were reviewed for change in the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle was obtained from preoperative radiographs. Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics and logistic regression were used to analyze risk factors for HA.
Results
13 hips (12 patients) (4.8%) underwent subsequent HA with labral repair and femoral-osteochondroplasty most common. No hips underwent THA and one revision PAO was performed. 13 hips experienced a complication and 90 hips underwent hardware removal. All PROM improved significantly post-operatively. Radiographically 80% of hips were in goal for acetabular correction parameters and amongst the LCEA, ACEA, AI and alpha angle (AA), only the AA was significant risk factor for subsequent arthroscopy.
Conclusion
Rectus sparing PAO is associated with a low rate of subsequent HA for intra-articular pathology at 5-year follow-up. Acetabular correction alone may be sufficient for the majority of patients with symptomatic acetabular dysplasia.
