Combined Periacetabular and Femoral Osteotomies for Severe Hip Deformities

• Published in: Clinical orthopaedics and related research 2009-09, Vol.467 (9), p.2221-2227
• Main Authors: Clohisy, John C., St John, Lauren C., Nunley, Ryan M., Schutz, Amanda L., Schoenecker, Perry L.
• Format: Article
• Language: English
• Subjects: Acetabulum - abnormalities; Acetabulum - diagnostic imaging; Acetabulum - surgery; Adolescent; Adult; Biological and medical sciences; Child; Cohort Studies; Conservative Orthopedics; Diseases of the osteoarticular system; Female; Femur - surgery; Hip Dislocation, Congenital - physiopathology; Hip Dislocation, Congenital - surgery; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Orthopedic surgery; Orthopedics; Osteotomy - methods; Pain - etiology; Pain - physiopathology; Postoperative Complications; Radiography; Range of Motion, Articular - physiology; Retrospective Studies; Severity of Illness Index; Sports Medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Orthopedics; Symposium: Papers Presented at the Annual Closed Meeting of the International Hip Society; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-0810-1

Periacetabular osteotomy (PAO) is an effective acetabular reorientation technique for treatment of symptomatic acetabular dysplasia. In hips with severe deformities, an adjunctive femoral osteotomy (PFO) may optimize correction, joint stability, and congruency. We analyzed the clinical and radiographic results of combined PAO/PFO in treating severe hip deformities. Second, we compared the clinical results of patients treated with PAO/PFO with patients treated with isolated PAO for lesser deformities. Twenty-five patients (28 hips) treated with PAO/PFO were reviewed and followed a minimum of 16 months (mean, 44 months). The matched PAO cohort included 25 patients (28 hips). For the PAO/PFO group, the average Harris hip score improved from 60.9 to 86.3. Eighty-nine percent of the patients demonstrated at least a 10-point improvement in the hip score and 75% had a Harris hip score over 80 points. Radiographic evaluation demonstrated consistent deformity correction. The PAO/PFO group had a lower average Harris hip score preoperatively, yet hip function after surgery was comparable between groups. These data indicate combined PAO/PFO is associated with improved hip function in most patients. These clinical results are comparable to those obtained with isolated PAO for lesser hip deformities. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.