Boston Children's Hospital, Boston, Massachusetts
Oakland Orthopaedic Surgeons, Royal Oak, Michigan.
J Bone Joint Surg Am. 2016 Apr 20;98(8):665-71. doi: 10.2106/JBJS.15.00735.
The age when patients present for treatment of symptomatic developmental dysplasia of the hip with periacetabular osteotomy (PAO) varies widely. Modifiable factors influencing age at surgery include preexisting activity level and body mass index (BMI). The severity of the hip dysplasia has also been implicated as a factor influencing the age at arthritis onset. The purpose of this study was to determine whether activity level, BMI, and severity of dysplasia are independent predictors of age of presentation for PAO.
A retrospective, institutional review board-approved review of prospectively collected data from a multicenter study group identified 708 PAOs performed for developmental dysplasia of the hip. Demographic factors that were considered in the analysis included age at surgery, BMI, history of hip disorder or treatment, and duration of symptoms. The severity of the developmental dysplasia of the hip was assessed by radiographic measurement of the lateral and anterior center-edge angles and acetabular inclination. Activity level was assessed with the University of California, Los Angeles (UCLA) activity score. Spearman correlations and t tests were used for univariable analysis. Multivariable regression analysis using generalized estimating equations was applied to determine independent predictors of age at PAO.
Univariable analysis indicated that age at presentation for treatment of PAO correlated with the lateral and anterior center-edge angles (p < 0.001), UCLA score (p < 0.001), and BMI (p = 0.04). Since the lateral and anterior center-edge angles were similarly correlated (Spearman rho = 0.61, p < 0.001), the lateral center-edge angle alone was used to classify the severity of the developmental dysplasia of the hip. Multivariable linear regression confirmed that a high UCLA score and severe hip dysplasia were independent predictors of age at PAO (p < 0.001).
A high activity level and severe dysplasia lead to the development of symptoms and presentation for PAO at significantly younger ages. The combination of these two factors has an even greater effect on decreasing the age at presentation for hip-preserving surgery. An increased BMI was not independently associated with a younger age at surgery. Modifying activity level may be beneficial in terms of delaying the onset of symptoms from developmental dysplasia of the hip.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
患有髋臼周围截骨术（PAO）治疗症状性发育性髋关节发育不良的患者就诊年龄差异很大。影响手术年龄的可改变因素包括现有活动水平和体重指数（BMI）。髋关节发育不良的严重程度也被认为是影响关节炎发病年龄的因素之一。本研究旨在确定活动水平、BMI 和发育不良的严重程度是否是 PAO 就诊年龄的独立预测因素。
回顾性分析多中心研究组前瞻性收集的数据，该研究组共纳入 708 例髋臼周围截骨术治疗发育性髋关节发育不良的患者。分析中考虑的人口统计学因素包括手术年龄、BMI、髋关节疾病或治疗史以及症状持续时间。通过测量外侧和前中心边缘角以及髋臼倾斜度来评估髋关节发育不良的严重程度。活动水平通过加利福尼亚大学洛杉矶分校（UCLA）活动评分进行评估。采用 Spearman 相关分析和 t 检验进行单变量分析。应用广义估计方程进行多变量回归分析，以确定 PAO 年龄的独立预测因素。
单变量分析表明，PAO 治疗的就诊年龄与外侧和前中心边缘角（p<0.001）、UCLA 评分（p<0.001）和 BMI（p=0.04）相关。由于外侧和前中心边缘角相关性相似（Spearman rho=0.61，p<0.001），因此仅使用外侧中心边缘角来对髋关节发育不良的严重程度进行分类。多变量线性回归证实，高 UCLA 评分和严重髋关节发育不良是 PAO 年龄的独立预测因素（p<0.001）。
高活动水平和严重发育不良会导致症状更早出现，并更早接受 PAO 治疗。这两个因素的结合对降低髋关节保护手术的就诊年龄有更大的影响。BMI 增加与手术年龄较小无关。改变活动水平可能有助于延迟发育性髋关节发育不良引起的症状发作。
预后 IV 级。有关证据水平的完整描述，请参见作者说明。
