Outcome of periacetabular osteotomy for the management of acetabular dysplasia : Experience in an academic centre

2011, N° 1 (Vol. 77/1) p.33-40
Neil G. Burke, Brian M. Devitt, Joseph F. Baker, Joseph S. Butler, Grainne Cousins, Damian McCormack, John M. O’Byrne
From Cappagh National Orthopaedic Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland

Abstract:
Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d'Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5° to 21° (p < 0.0001) in anteverted hips, and from 9° to 30° in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6° to 35° (p < 0.0001) in anteverted hips, and in neutral or retroverted hips from 9° to 30° (p < 0.0001). The acetabular index improved from 26° to 8° (p < 0.0001) in anteverted hips, and from 21° to 7° (p < 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging.

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