Harris Michael D, Thapa Susan, Lieberman Elizabeth G, Pascual-Garrido Cecilia, Abu-Amer Wahid, Nepple Jeffrey J, Clohisy John C
Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
J Bone Joint Surg Am. 2024 Dec 18;106(24):2322-2329. doi: 10.2106/JBJS.24.00308. Epub 2024 Oct 15.
Developmental dysplasia of the hip (DDH) can cause pain and premature osteoarthritis. The risk factors and timing for disease progression in adolescents and young adults have not been fully defined. This study aimed to determine the prevalence of and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on a dysplastic hip.
Patients undergoing unilateral PAO for DDH were followed for at least 2 years and categorized into contralateral pain and no-pain groups and contralateral surgery and no-surgery groups. Pain was defined with the modified Harris hip score. Univariate analysis tested group differences in demographics, radiographic measures, and range of motion. Kaplan-Meier survival analysis was used to assess pain development and surgery in the contralateral hip over time. Multivariable regression identified risk factors for contralateral pain and surgery. Contralateral pain and surgery predictors were secondarily assessed after categorization of the contralateral hips as dysplastic, borderline, and non-dysplastic and in subgroups based on the lateral center-edge angle (LCEA) and acetabular inclination (AI) in 5° increments.
One hundred and eighty-four patients were followed for a mean of 4.6 ± 1.6 years (range, 2.0 to 8.8 years), during which 51% (93) reported contralateral hip pain and 33% (60) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% with contralateral pain development as the end point and 66% with contralateral surgery as the end point. Painful hips exhibited more severe dysplasia compared with no-pain hips (LCEA = 16.5° versus 20.3°, p < 0.001; AI = 13.2° versus 10.0°, p < 0.001). AI was the sole predictor of pain, with every 1° increase in the AI raising the risk by 11%. Surgically treated hips also had more severe dysplasia (LCEA = 14.9° versus 20.0°, p < 0.001; AI = 14.7° versus 10.2°, p < 0.001) and were in younger patients (21.6 versus 24.1 years, p = 0.022). AI and a maximum alpha angle of ≥55° were predictors of contralateral surgery.
At 5 years after hip PAO, approximately 50% of contralateral hips will have pain and approximately 35% can be expected to need surgery. More severe dysplasia, based on the LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
发育性髋关节发育不良（DDH）可导致疼痛和过早出现骨关节炎。青少年和年轻成人疾病进展的风险因素及时间尚未完全明确。本研究旨在确定发育不良髋关节行髋臼周围截骨术（PAO）后对侧髋关节疼痛及手术的发生率和风险因素。
对因DDH接受单侧PAO的患者进行至少2年的随访，并分为对侧疼痛组和无疼痛组以及对侧手术组和无手术组。采用改良Harris髋关节评分定义疼痛。单因素分析检验人口统计学、影像学测量和活动范围的组间差异。采用Kaplan-Meier生存分析评估对侧髋关节随时间的疼痛发展和手术情况。多变量回归确定对侧疼痛和手术的风险因素。在将对侧髋关节分类为发育不良、临界和非发育不良以及根据外侧中心边缘角（LCEA）和髋臼倾斜度（AI）以5°增量分组的亚组中，对侧疼痛和手术预测因素进行二次评估。
184例患者平均随访4.6±1.6年（范围2.0至8.8年），在此期间，51%（93例）报告对侧髋关节疼痛，33%（60例）接受对侧手术。Kaplan-Meier分析预测，以对侧疼痛发展为终点的5年生存率为49%，以对侧手术为终点的5年生存率为66%。与无疼痛的髋关节相比，疼痛的髋关节发育不良更严重（LCEA = 16.5°对20.3°，p < 0.001；AI = 13.2°对10.0°，p < 0.001）。AI是疼痛的唯一预测因素，AI每增加1°，风险增加11%。接受手术治疗的髋关节发育不良也更严重（LCEA = 14.9°对20.0°，p < 0.001；AI = 14.7°对10.2°，p < 0.001），且患者年龄更小（21.6岁对24.1岁，p = 0.022）。AI和最大α角≥55°是对侧手术的预测因素。
髋关节PAO术后5年，约50%的对侧髋关节会出现疼痛，约35%预计需要手术。基于LCEA和AI，更严重的发育不良会增加对侧髋关节疼痛和手术的风险，AI是两种结果的预测因素。了解这些风险可为患者咨询和治疗计划提供参考。
预后III级。有关证据水平的完整描述，请参阅作者指南。
