Top

International Orthopaedics

Published in:

01-06-2018 | Original Paper

The prevalence and risk factors for delayed union of the superior pubic ramus at one year after curved periacetabular osteotomy: its risk factor and outcome

Authors: Ayumi Matsunaga, Shunsuke Akiho, Koichi Kinoshita, Masatoshi Naito, Takuaki Yamamoto

Published in: International Orthopaedics | Issue 6/2018

Abstract

Purpose

Curved periacetabular osteotomy (CPO) has been developed for the treatment of acetabular dysplasia. While several studies have reported its good clinical results, the complications of CPO include delayed union and nonunion of the superior pubic ramus. The purpose of this study is to investigate the prevalence of delayed union of the pubis one year after CPO, and to determine the risk factors for this complication.

Methods

The study examined 113 hips that underwent CPO between 2008 and 2012. Delayed union was assessed based on the anteroposterior radiography one year after CPO. A superior pubic ramus union group (U group) and a delayed union group (D group) were retrospectively compared regarding patient characteristics, clinical evaluations, and radiographic parameters.

Results

Delayed union rate was 16.8%. The D group contained a significantly greater proportion of smokers (p < 0.001). The gap at the pubic osteotomy site on CT coronal images was significantly larger in the D group (p < 0.001), and the cut-off value for the risk of nonunion was larger than 5.1 mm. Multivariate regression analysis indicated that smoking (OR 10.7, 95% CI 2.1–55.4) and a gap at the superior pubic ramus >5.1 mm (OR 16.5, 95% CI 3.7–73.7) were significantly associated with delayed union as independent risk factors.

Conclusion

The prevalence of delayed union one year after CPO was 16.8%. Smoking and a gap larger than 5.1 mm at the pubic osteotomy site are risk factors for delayed union after CPO.

Aronson J (1986) Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect 35:119–128PubMed

Nakamura S, Ninomiya S, Nakamura T (1989) Primary osteoarthritis of the hip joint in Japan. Clin Orthop Relat Res 241:190–196

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

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

Clohisy JC, Schutz AL, John LS, Schoenecker PL, Wright RW (2009) Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res 467(8):2041–2052CrossRefPubMedPubMedCentral

Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V (2005) The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7-15-year follow-up of 26 hips. Acta Orthop 76(6):833–840CrossRefPubMed

Matta JM, Stover MD, Siebenrock K (1999) Periacetabular osteotomy through the smith-Petersen approach. Clin Orthop Relat Res 363:21–32

Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL (2005) Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am 87(2):254–259CrossRefPubMed

Clohisy JC, Nunley RM, Curry MC, Schoenecker PL (2007) Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am 89(7):1417–1423PubMed

10.

Davey JP, Santore RF (1999) Complications of periacetabular osteotomy. Clin Orthop Relat Res 363:33–37CrossRef

11.

Peters CL, Erickson JA, Hines JL (2006) Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am 88(9):1920–1926PubMed

12.

Siebenrock KA, Schöll E, Lottenbach M, Ganz R (1999) Bernese periacetabular osteotomy. Clin Orthop Relat Res 363:9–20CrossRef

13.

Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL (1995) Periacetabular and intertrochamteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am 77(1):73–85CrossRefPubMed

14.

Trumble SJ, Mayo KA, Mast JW (1999) The periacetabular osteotomy. Minimum 2 year follow up in more than 100 hips. Clin Orthop Relat Res 363:54–63CrossRef

15.

Zaltz I, Baca G, Kim YJ, Schoenecker P, Trousdale R, Sierra R, Sucato D, Sink E, Beaulé P, Millis MB, Podeszwa D, Clohisy JC (2014) Complications associated with the periacetabular osteotomy: a prospective multicenter study. J Bone Joint Surg Am 96(23):1967–1974CrossRefPubMed

16.

Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81(12):1747–1770CrossRefPubMed

17.

Wiberg G (1939) The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand 83(Suppl 58):7–38

18.

Teratani T, Naito M, Shiramizu K, Nakamura Y, Moriyama S (2008) Modified pubic osteotomy for medialization of the femoral head in periacetabular osteotomy: a retrospective study of 144 hips. Acta Orthop 79(4):474–482CrossRefPubMed

19.

Massie WK, Howorth MB (1950) Congenital dislocation of the hip. Part I. Method of grading results. J Bone Joint Surg Am 32-A(3):519–531CrossRefPubMed

20.

Yasunaga Y, Takahashi K, Ochi M, Ikuta Y, Hisatome T, Nakashiro J, Yamamoto S (2003) Rotational acetabular osteotomyin patients forty-six years of age or older: comparison with younger patients. J Bone Joint Surg Am 85:266–272CrossRefPubMed

21.

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

22.

Lee JJ, Patel R, Biermann JS, Dougherty PJ (2013) The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am 95(9):850–859CrossRefPubMed

23.

Brown CW, Orme TJ, Richardson HD (1986) The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine 11(9):942–943CrossRefPubMed

24.

Andersen T, Christensen FB, Laursen M, Høy K, Hansen ES, Bünger C (2001) Smoking as a predictor of negative outcome in lumbar spinal fusion. Spine 26(23):2623–2628CrossRefPubMed

25.

Møller AM, Villebro N, Pedersen T, Tønnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomized clinical trial. Lancet 359(9301):114–117CrossRefPubMed

Title: The prevalence and risk factors for delayed union of the superior pubic ramus at one year after curved periacetabular osteotomy: its risk factor and outcome
Authors: Ayumi Matsunaga
Shunsuke Akiho
Koichi Kinoshita
Masatoshi Naito
Takuaki Yamamoto
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3706-9

At a glance: The STEP trials

Springer Medicine

The prevalence and risk factors for delayed union of the superior pubic ramus at one year after curved periacetabular osteotomy: its risk factor and outcome

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2018

Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays

Ganglion cysts of the proximal tibiofibular articulation: the role of arthrodesis and combined partial fibula excision

Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data

Treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children

Comments on treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children

Long-term results of custom cementless-stem total hip arthroplasty performed in hip fusion