Top

Clinical Orthopaedics and Related Research®

Published in:

01-05-2013 | Clinical Research

Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH

Authors: Christoph E. Albers, MD, Simon D. Steppacher, MD, Reinhold Ganz, MD, Moritz Tannast, MD, Klaus A. Siebenrock, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2013

Abstract

Background

Although periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) provides conceptual advantages compared with other osteotomies and reportedly is associated with joint survivorship of 60% at 20 years, the beneficial effect of proper acetabular reorientation with concomitant arthrotomy and creation of femoral head-neck offset on 10-year hip survivorship remains unclear.

Questions/purposes

We asked the following questions: (1) Does the 10-year survivorship of the hip after PAO improve with proper acetabular reorientation and a spherical femoral head; (2) does the Merle d’Aubigné-Postel score improve; (3) can the progression of osteoarthritis (OA) be slowed; and (4) what factors predict conversion to THA, progression of OA, or a Merle d’Aubigné-Postel score less than 15 points?

Methods

We retrospectively reviewed 147 patients who underwent 165 PAOs for DDH with two matched groups: Group I (proper reorientation and spherical femoral head) and Group II (improper reorientation and aspherical femoral head). We compared the Kaplan-Meier survivorship, Merle d’Aubigné-Postel scores, and progression of OA in both groups. A Cox regression analysis (end points: THA, OA progression, or Merle d’Aubigné-Postel score less than 15) was performed to detect factors predicting failure. The minimum followup was 10 years (median, 11 years; range, 10–14 years).

Results

An increased survivorship was found in Group I. The Merle d’Aubigné-Postel score did not differ. Progression of OA in Group I was slower than in Group II. Factors predicting failure included greater age, lower preoperative Merle d’Aubigné-Postel score, and the presence of a Trendelenburg sign, aspherical head, OA, subluxation, postoperative acetabular retroversion, excessive acetabular anteversion, and undercoverage.

Conclusions

Proper acetabular reorientation and the creation of a spherical femoral head improve long-term survivorship and decelerate OA progression in patients with DDH.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Apley AG, Wientroub S. The sagging rope sign in Perthes’ disease and allied disorders. J Bone Joint Surg Br. 1981;63:43–47.PubMed

Cox DR. Regression models and life-tables. J Roy Stat Soc B. 1972;34:187–191.

D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.PubMed

de Kleuver M, Kapitein PJ, Kooijman MA, van Limbeek J, Pavlov PW, Veth RP. Acetabular coverage of the femoral head after triple pelvic osteotomy: no relation to outcome in 51 hips followed for 8–15 years. Acta Orthop Scand. 1999;70:583–588.PubMedCrossRef

de Kleuver M, Kooijman MA, Pavlov PW, Veth RP. Triple osteotomy of the pelvis for acetabular dysplasia: results at 8 to 15 years. J Bone Joint Surg Br. 1997;79:225–229.PubMedCrossRef

Eijer H, Leunig M, Mohamed N, Ganz R. Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int. 2001;11:37–41.

Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36.PubMed

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed

Golub BS. The Duchenne-Trendelenburg sign. Bull Hosp Joint Dis. 1947;8:127–136.PubMed

10.

Hananouchi T, Yasui Y, Yamamoto K, Toritsuka Y, Ohzono K. Anterior impingement test for labral lesions has high positive predictive value. Clin Orthop Relat Res. 2012;470:3524–3529.PubMedCrossRef

11.

Hartig-Andreasen C, Troelsen A, Thillemann TM, Soballe K. What factors predict failure 4 to 12 years after periacetabular osteotomy? Clin Orthop Relat Res. 2012;470:2978–2987.PubMedCrossRef

12.

Hipp JA, Sugano N, Millis MB, Murphy SB. Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res. 1999;364:134–143.PubMedCrossRef

13.

Holm I, Bolstad B, Lutken T, Ervik A, Rokkum M, Steen H. Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Physiother Res Int. 2000;5:241–248.PubMedCrossRef

14.

Hsieh PH, Shih CH, Lee PC, Yang WE, Lee ZL. A modified periacetabular osteotomy with use of the transtrochanteric exposure. J Bone Joint Surg Am. 2003;85:244–250.PubMedCrossRef

15.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRef

16.

Kirmit L, Karatosun V, Unver B, Bakirhan S, Sen A, Gocen Z. The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists. Clin Rehabil. 2005;19:659–661.PubMedCrossRef

17.

Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V. The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7–15-year follow-up of 26 hips. Acta Orthop. 2005;76:833–840.PubMedCrossRef

18.

Lequesne M, de Seze S. [False profile of the pelvis: a new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies][in French]. Rev Rhum Mal Osteoartic. 1961;28:643–652.PubMed

19.

Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res. 1993;292:62–76.PubMed

20.

Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80.PubMedCrossRef

21.

Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009;91:2113–2123.PubMedCrossRef

22.

Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–989.PubMed

23.

Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:93–99.PubMedCrossRef

24.

Naito M, Shiramizu K, Akiyoshi Y, Ezoe M, Nakamura Y. Curved periacetabular osteotomy for treatment of dysplastic hip. Clin Orthop Relat Res. 2005;433:129–135.PubMedCrossRef

25.

Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the rick of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.PubMedCrossRef

26.

Ohashi H, Hirohashi K, Yamano Y. Factors influencing the outcome of Chiari pelvic osteotomy: a long-term follow-up. J Bone Joint Surg Br. 2000;82:517–525.PubMedCrossRef

27.

Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res. 2010;468:504–510.PubMedCrossRef

28.

Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.PubMedCrossRef

29.

Siebenrock KA, Leunig M, Ganz R. Periacetabular osteotomy: the Bernese experience. Instr Course Lect. 2001;50:239–245.PubMed

30.

Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.PubMedCrossRef

31.

Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004:418;54–60.PubMedCrossRef

32.

Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949;31:40–46.

33.

Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644.PubMedCrossRef

34.

Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res. 2008;466:782–790.PubMedCrossRef

35.

Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The Hip. Proceedings of the 3rd Meeting of The Hip Society. St Louis, MO, USA: CV Mosby Co; 1975:212–228.

36.

Tannast M, Albers CE, Steppacher SD, Siebenrock KA. Hip pain in the young adult. In: Bentley G, ed. European Instructional Lectures. Berlin, Germany: Springer; 2011:141–154.CrossRef

37.

Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm: reliable and validated. J Orthop Res. 2008;26:1199–1205.PubMedCrossRef

38.

Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.PubMedCrossRef

39.

Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, Siebenrock KA. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–190.PubMedCrossRef

40.

Tönnis D. General radiography of the hip joint. In: Tönnis D, ed. Congenital Dysplasia, Dislocation of the Hip. New York, NY, USA: Springer; 1987:100–142.CrossRef

41.

Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.PubMed

42.

Troelsen A, Elmengaard B, Soballe K. A new minimally invasive transsartorial approach for periacetabular osteotomy. J Bone Joint Surg Am. 2008;90:493–498.PubMedCrossRef

43.

Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am. 2009;91:2169–2179.PubMedCrossRef

44.

van Hellemondt GG, Sonneveld H, Schreuder MH, Kooijman MA, de Kleuver M. Triple osteotomy of the pelvis for acetabular dysplasia: results at a mean follow-up of 15 years. J Bone Joint Surg Br. 2005;87:911–915.PubMedCrossRef

45.

Weber M, Ganz R. The Bernese periacetabular osteotomy. Operat Orthop Traumatol. 2002;2:99–121.CrossRef

46.

Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand. 1939;83:7–38.

47.

Xie J, Naito M, Maeyama A. Evaluation of acetabular versions after a curved periacetabular osteotomy for dysplastic hips. Int Orthop. 2010;34:473–477.PubMedCrossRef

48.

Yanagimoto S, Hotta H, Izumida R, Sakamaki T. Long-term results of Chiari pelvic osteotomy in patients with developmental dysplasia of the hip: indications for Chiari pelvic osteotomy according to disease stage and femoral head shape. J Orthop Sci. 2005;10:557–563.PubMedCrossRef

49.

Zheng G, Tannast M, Anderegg C, Siebenrock KA, Langlotz F. Hip2Norm: an object-oriented cross-platform program for 3D analysis of hip joint morphology using 2D pelvic radiographs. Comput Methods Programs Biomed. 2007;87:36–45.PubMedCrossRef

50.

Ziebarth K, Balakumar J, Domayer S, Kim YJ, Millis MB. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2011;469:447–453.PubMedCrossRef

Title: Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH
Authors: Christoph E. Albers, MD
Simon D. Steppacher, MD
Reinhold Ganz, MD
Moritz Tannast, MD
Klaus A. Siebenrock, MD
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 5/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2799-8

At a glance: The STEP trials

Springer Medicine

Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 5/2013

No Better Flexion or Function of High-flexion Designs in Asian Patients With TKA

Proximal Tibial Bone Density Is Preserved After Unicompartmental Knee Arthroplasty

Orthopaedic Residency Applications Increase After Implementation of 80-hour Workweek

Erratum to: Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care

Brief Followup Report: Does High-flexion Total Knee Arthroplasty Allow Deep Flexion Safely in Asian Patients?

Painful Patellar Clunk or Crepitation of Contemporary Knee Prostheses