Title : Does pre-operative dysplasia severity influence functional outcomes after periacetabular osteotomy?
Abstract:
The influence of pre-operative dysplasia severity on the outcomes of PeriAcetabular Osteotomy (PAO) has not been thoroughly investigated. It remains unclear whether the benefits of PAO in patients with mild dysplasia outweigh the potential risks associated with this challenging procedure. The purpose of this study was to compare functional outcomes between patients with mild dysplasia and those with moderate-severe dysplasia at a minimum of two years after PAO.
A total of 106 consecutive patients (94 female; mean age 27.5 years) who underwent PAO for acetabular dysplasia by a single surgeon and had completed a minimum of two years follow-up were identified. Patients were categorised into two groups according to their pre-operative dysplasia severity: mild (lateral centre edge angle (LCEA) 18-25º; n=40) and moderate-severe (LCEA <18º; n=66). The two groups were then compared with respect to baseline variables, surgical characteristics, two-year patient-reported outcome measures (International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, University of California Los Angeles (UCLA) activity score, pain visual analogue score (VAS)) and complication rate.
The mild dysplasia group underwent concomitant procedures less frequently (5% vs. 12%, p<0.001), received a lower LCEA correction (mean 16.6º vs. 23.0º, p<0.001) and demonstrated a higher postoperative LCEA (mean 36.5º vs. 32.8º, p<0.001) than the moderate-severe dysplasia group. There were otherwise no significant differences in baseline or surgical variables between the two groups (all p>0.05).
The two groups demonstrated significant postoperative improvements across all functional outcome measures. There was no significant difference in the primary outcome measure of two-year iHOT-12 score between the two groups (mean score 80.3 (mild group) vs. 82.2 (moderate-severe group), p=0.201). There were no significant differences in all other patient-reported outcome measures or in complication rate between the two groups (all p>0.05).
We found that patients with mild dysplasia benefit significantly from PAO, achieving similar functional outcomes to patients with moderate-severe dysplasia two years after PAO. Our results suggest that severity of dysplasia should not be considered in isolation as an indication or contraindication for PAO.
During this presentation we wish to discuss the benefits of PAO procedures and the indications for patient selection as have been found in our research.
