Hara Daisuke, Hamai Satoshi, Fukushi Jun-Ichi, Kawaguchi Ken-Ichi, Motomura Goro, Ikemura Satoshi, Komiyama Keisuke, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Sports Med. 2017 Sep;45(11):2468-2475. doi: 10.1177/0363546517707942. Epub 2017 Jun 6.
Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear.
To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade.
Case-control study; Level of evidence, 3.
The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO.
The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4.
Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.
髋臼周围截骨术（PAO）是治疗有症状的髋臼发育不良的有效方法。然而，这些患者术后参与运动是否会导致骨关节炎（OA）的凯尔格伦-劳伦斯（KL）分级进展尚不清楚。
研究（1）PAO术前和术后的运动参与情况，以及（2）术后参与运动是否会导致KL分级进展。
病例对照研究；证据等级，3级。
作者回顾性分析了1998年至2011年间因有症状的髋臼发育不良接受PAO且术前KL分级为1级或2级的161例患者（183髋）的数据。手术时的平均年龄为42.0±10.9岁（范围12 - 64岁），平均随访时间为100个月（范围13 - 180个月）。数据包括运动参与情况、加利福尼亚大学洛杉矶分校（UCLA）活动量表评分、手术时年龄、体重指数、随访时间、发育性髋关节脱位治疗史、Merle d'Aubigné - Postel评分、牛津髋关节评分、中心边缘角和KL分级。应用单因素和多因素分析来确定哪些因素与PAO后进展至KL 3级或4级相关。
参与运动的患者数量从术前的50例（31.1%）显著增加到术后的89例（55.3%）。UCLA平均评分从术前的4.7±2.1显著增加到术后的5.5±2.0。16髋的KL分级进展至3级或4级，其中4髋改行全髋关节置换术。KL 1级或2级与KL 3级或4级的髋关节在术后运动参与情况（分别为89髋[53.3%]对11髋[68.8%]；P = 0.24）和UCLA评分（分别为5.6±2.0对5.1±2.0；P = 0.30）方面未发现显著差异。多因素分析显示，包括术后运动参与情况在内的任何因素与进展至KL 3级或4级均无显著相关性。
PAO术后参与运动在中期随访时对KL分级进展没有显著的负面影响。
