Abstract
Introduction
Acetabular retroversion is an accepted cause of Pincer-type femoroacetabular impingement. There is increasing evidence that acetabular retroversion is rather a rotational abnormality of the pelvis than an overgrowth of the acetabular wall or even a dysplasia of the posterior wall. Initially, patients with a retroverted acetabulum were treated with an open rim trimming through a surgical hip dislocation (SHD) based on the early understanding of the pathomorphology. Theoretically, the reduction of the anterior wall can decrease the already small joint contact area in retroverted hips to a critical size. Based on the most recent literature, anteverting periacetabular osteotomy (PAO) seems to be the more appropriate surgical treatment. With this technique, the anterior impingement conflict can be treated efficiently without compromising the joint contact area. However, it is unknown whether this theoretical advantage in turn results in better mid term results of treatment.
Objectives
We asked if anteverting PAO results in better clinical and radiographical mid term results compared to rim trimming through a surgical hip dislocation.
Methods
We performed a retrospective comparative study based on 257 hips (221 patients) with symptomatic femoroacetabular impingement due to acetabular retroversion. Acetabular retroversion was defined by a cross-over sign, a posterior wall sign, and a positive ischial spine sign. We then formed two matched groups consisting of 73 hips undergoing open acetabular rim trimming and 54 hips with an anteverting periacetabular osteotomy. Patients with incomplete radiographic documentation, previous surgery, and hip dysplasia (LCE < 20°) were excluded. Some patients were excluded due to a matching process (Fig. 1). Patients were generally followed clinically and radiographically after two, five and ten years. A Kaplan-Meier survivorship analysis was performed using the following endpoints: a low clinical score, radiographic progression of osteoarthritis, and/or the conversion to total hip arthroplasty. The Log Rank Score was used to compare the two survivorship curves.
Results
Patients undergoing anteverting PAO for acetabular retroversion had a significantly increased survivorship (82%, 95% confidence interval, 72–91%) at seven years in comparison to open surgical rim trimming (63%, 95%CI, 49–76%, p<0.0001). The two survivorship curves are comparable for the first four years with a substantial drop for the rim trimming group after year five (Fig. 2).
Conclusion
This study proofs for the first time that the theoretical advantages of anteverting periacetabular osteotomy in hips with symptomatic acetabular retroversion results in an increased survivorship at mid term follow-up in comparison to open rim trimming.
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