Verhaegen Jeroen, Salih Saif, Thiagarajah Shankar, Grammatopoulos George, Witt Johan D
University Hospital Antwerp, Edegem, Belgium.
Orthopaedics, University College Hospital, London, UK.
Bone Jt Open. 2021 Sep;2(9):757-764. doi: 10.1302/2633-1462.29.BJO-2021-0096.R2.
Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome.
A single-centre, retrospective cohort study was performed on patients with acetabular retroversion treated with PAO (n = 62 hips). Acetabular retroversion was diagnosed clinically and radiologically (presence of a crossover sign, posterior wall sign, lateral centre-edge angle (LCEA) between 20° and 35°). Outcomes were compared with a control group of patients undergoing PAO for dysplasia (LCEA < 20°; n = 86 hips). Femoral version was recorded. Patient-reported outcome measures (PROMs), complications, and reoperation rates were measured.
The mean Non-Arthritic Hip Score (NAHS) preoperatively was 58.6 (SD 16.1) for the dysplastic hips and 52.5 (SD 12.7) for the retroverted hips (p = 0.145). Postoperatively, mean NAHS was 83.0 (SD 16.9) and 76.7 (SD 17.9) for dysplastic and retroverted hips respectively (p = 0.041). Difference between pre- and postoperative NAHS was slightly lower in the retroverted hips (18.3 (SD 22.1)) compared to the dysplastic hips (25.2 (SD 15.2); p = 0.230). At mean 3.5 years' follow-up (SD 1.9), one hip needed a revision PAO and no hips were converted to total hip arthroplasty (THA) in the retroversion group. In the control group, six hips (7.0%) were revised to THA. No differences in complications (p = 0.106) or in reoperation rate (p = 0.087) were seen. Negative predictors of outcome for patients undergoing surgery for retroversion were female sex, obesity, hypermobility, and severely decreased femoral anteversion.
A PAO is an effective surgical intervention for acetabular retroversion and produces similar improvements when used to treat dysplasia. Femoral version should be routinely assessed in these patients and when extremely low (< 0°), as an additional procedure to address this abnormality may be necessary. Females with signs of hypermobility should also be consulted of the likely guarded improvement. Cite this article: 2021;2(9):757-764.
髋臼周围截骨术（PAO）是治疗髋臼发育不良的既定方法。它也被提议用于治疗髋臼后倾患者。通过回顾一个大型队列，我们旨在测试两种形态类型的治疗结果是否等效，并确定影响结果的因素。
对接受PAO治疗的髋臼后倾患者（n = 62髋）进行了一项单中心回顾性队列研究。通过临床和放射学方法诊断髋臼后倾（存在交叉征、后壁征、外侧中心边缘角（LCEA）在20°至35°之间）。将结果与接受PAO治疗发育不良的对照组患者（LCEA < 20°；n = 86髋）进行比较。记录股骨扭转角度。测量患者报告的结局指标（PROMs）、并发症和再次手术率。
发育不良髋关节术前平均非关节炎髋关节评分（NAHS）为58.6（标准差16.1），后倾髋关节为52.5（标准差12.7）（p = 0.145）。术后，发育不良和后倾髋关节的平均NAHS分别为83.0（标准差16.9）和76.7（标准差17.9）（p = 0.041）。后倾髋关节术前和术后NAHS的差异（18.3（标准差22.1））略低于发育不良髋关节（25.2（标准差15.2）；p = 0.230）。在平均3.5年的随访（标准差1.9）中，后倾组有1髋需要翻修PAO，无髋转换为全髋关节置换术（THA）。在对照组中，有6髋（7.0%）翻修为THA。并发症（p = 0.106）或再次手术率（p = 0.087）未见差异。后倾手术患者结局的负面预测因素为女性、肥胖、关节活动过度和股骨前倾角严重减小。
PAO是治疗髋臼后倾的有效手术干预措施，用于治疗发育不良时也能产生类似的改善效果。这些患者应常规评估股骨扭转角度，当角度极低（< 0°）时，可能需要额外进行手术来纠正这一异常。对于有关节活动过度迹象的女性，也应告知其可能改善效果有限。引用本文：2021；2(9):757 - 764。
