Lara Joaquín, Garín Alan, Herrera Cristhián, Abara Selim, Besomi Javier, Villegas Diego, Neumann Hassan, Tobar Carlos
Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile.
J Hip Preserv Surg. 2020 Apr 13;7(2):256-261. doi: 10.1093/jhps/hnaa014. eCollection 2020 Jul.
Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19-31), 96% females. Mean follow-up 7 years (range: 3-16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.
发育性髋关节发育不良（DDH）已被认为是一种导致骨关节炎的疾病。髋臼周围截骨术（PAO）在这些病例的髋关节保留治疗中显示出良好的效果。然而，关节内损伤可能是术后持续症状的原因，因此在PAO之前或期间治疗关节损伤已成为解决这一问题的替代方法。目的是确定关节内损伤的患病率、接受PAO但未治疗关节内病变的患者的功能结果以及长期随访时全髋关节置换术（THA）的无翻修生存率。对92例患者的103个髋关节进行回顾性研究，平均年龄26岁（19 - 31岁），96%为女性。平均随访7年（范围：3 - 16年）。在进行PAO之前，用高分辨率磁共振成像（MRI）评估关节内损伤，使用国际软骨修复协会分类评估软骨损伤。所有患者均获得Harris髋关节评分（HHS）。100%的病例在MRI上有盂唇撕裂，80.8%有肥厚性盂唇，20.8%有盂唇旁囊肿。88.5%的髋关节髋臼软骨损伤为2级。94%的患者HHS为良好和优秀。15年时THA的无翻修生存率为87%。软骨盂唇损伤在DDH患者中很常见。尽管如此，PAO在不进行盂唇修复的情况下仍能取得优异的效果。我们认为重点应放在DDH患者髋关节的生物力学和解剖学矫正上。
