Muffly Brian T, Trotzky Zachary A, Fowler Mia J, Nawabi Danyal H, Carli Alberto V, Sink Ernest L
Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.
Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2025 Aug;40(8S1):S216-S221. doi: 10.1016/j.arth.2025.04.051. Epub 2025 Apr 28.
Patient acceptable symptomatic state (PASS) achievement, reoperation rates, and survivorship were compared between periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia and total hip arthroplasty (THA) in patients aged 40 to 49 years.
Patients aged 40 to 49 years undergoing PAO or THA were retrospectively reviewed. The PAO patients who had a body mass index (BMI) ≥ 30 or a Tönnis grade ≥ 2 were excluded. The THA patients who had a BMI ≥ 30, a Tönnis grade ≥ 3, or arthritic etiologies following slipped capital femoral epiphysis, Legg-Calve-Perthes, osteonecrosis, and/or trauma were excluded. Postoperative modified Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score-Joint Replacement were collected at a minimum of 1 year following PAO and THA, respectively (mean follow-up 3.7 versus 3.2 years). Established 2-year thresholds defined PASS. Survival analysis compared procedures with an endpoint of subsequent ipsilateral surgery (excluding hardware removal). There were 103 hips (n = 42 PAO, n = 61 THA) analyzed. Sex, average age, BMI, and lateral center edge angle within the PAO group were 95.2% women, 43 years, 23.1, and 16.9 degrees, respectively, compared to 78.7% women, 45 years, 24.2, and 20.0 degrees in the THA group (P = 0.02, <0.01, 0.10, and 0.10, respectively).
There were 72% of PAO compared to 61% of THA patients who achieved PASS (P = 0.28). History of prior ipsilateral surgery was associated with failure to achieve PASS (37 versus 6%, P < 0.001). The rate of subsequent surgery was 5% in each cohort (P = 1.0). The mean time-to-event was 11.2 and 7.8 years in the PAO and THA cohorts, respectively. Survivorship free of reoperation was 91% at five and 8 years among PAOs and 95% at five and 8 years among THAs (P = 0.94).
Patients aged 40 to 49 years undergoing PAO and THA have similar PASS achievement without differences in reoperation. Both procedures are viable surgical options in quadragenarians, with high survivorship maintained at five and 8 years. Thoughtful patient and physician dialogue incorporating all management options and the patient's goals should drive surgical decision-making.
比较40至49岁有症状的髋臼发育不良患者行髋臼周围截骨术（PAO）和全髋关节置换术（THA）后的患者可接受症状状态（PASS）达成情况、再次手术率和生存率。
对40至49岁接受PAO或THA的患者进行回顾性研究。排除体重指数（BMI）≥30或Tönnis分级≥2的PAO患者。排除BMI≥30、Tönnis分级≥3或患有股骨头骨骺滑脱、Legg-Calvé-Perthes病、骨坏死和/或创伤后关节炎病因的THA患者。分别在PAO和THA术后至少1年收集改良Harris髋关节评分和髋关节残疾与骨关节炎结果评分-关节置换（平均随访时间分别为3.7年和3.2年）。既定的2年阈值定义PASS。生存分析比较以随后同侧手术（不包括取出内固定）为终点的手术。共分析了103髋（PAO组42髋，THA组61髋）。PAO组的性别、平均年龄、BMI和外侧中心边缘角分别为女性占95.2%、43岁、23.1和16.9度，而THA组分别为女性占78.7%、45岁、24.2和20.0度（P值分别为0.02、<0.01、0.10和0.10）。
达到PASS的PAO患者为72%，THA患者为61%（P = 0.28）。既往同侧手术史与未达到PASS相关（37%对6%，P < 0.001）。每个队列的后续手术率均为5%（P = 1.0）。PAO和THA队列的平均至事件时间分别为11.2年和7.8年。PAO在5年和8年时无再次手术的生存率为91%，THA在5年和8年时为95%（P = 0.94）。
40至49岁接受PAO和THA的患者在PASS达成方面相似，再次手术无差异。这两种手术都是四十多岁患者可行的手术选择，在5年和8年时均保持高生存率。患者与医生进行充分沟通，综合考虑所有治疗方案和患者目标，应推动手术决策。
