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Anteverting Periacetabular Osteotomy for Symptomatic Acetabular Retroversion: Results at Ten Years

Siebenrock, Klaus A. MD; Schaller, Claudio MD; Tannast, Moritz MD; Keel, Marius MD; Büchler, Lorenz MD

Journal of Bone & Joint Surgery - American Volume: 5 November 2014 - Volume 96 - Issue 21 - p 1785–1792
doi: 10.2106/JBJS.M.00842
Scientific Articles
Supplementary Content
Disclosures

Background: Acetabular retroversion is associated with pincer-type femoroacetabular impingement and can lead to hip osteoarthritis. We report the ten-year results of a previously described patient cohort that had corrective periacetabular osteotomy for the treatment of symptomatic acetabular retroversion.

Methods: Clinical and radiographic parameters were assessed preoperatively and at two and ten years postoperatively. A Kaplan-Meier survivorship analysis of the twenty-two patients (twenty-nine hips) with a mean follow-up (and standard deviation) of 11 ± 1 years (range, nine to twelve years) was performed. In addition, a univariate Cox regression analysis was done with conversion to total hip arthroplasty as the primary end point and progression of the osteoarthritis, a fair or poor result according to the Merle d’Aubigné score, or the need for revision surgery as the secondary end points.

Results: The mean Merle d’Aubigné score improved significantly from 14 ± 1.4 points (range, 12 to 17 points) preoperatively to 16.9 ± 0.9 points (range, 15 to 18 points) at ten years (p < 0.001). There were also significant improvements with regard to hip flexion (p = 0.003), internal rotation (p = 0.003), and adduction (p = 0.002) compared with the preoperative status. No significant increase of the mean Tönnis osteoarthritis score was seen at ten years (p = 0.06). The cumulative ten-year survivorship, with conversion to a total hip arthroplasty as the primary end point, was 100%. The cumulative ten-year survivorship in achievement of one of the secondary end points was 71% (95% confidence interval, 54% to 88%). Predictors for poor outcome were the lack of femoral offset creation and overcorrection of the acetabular version resulting in excessive anteversion.

Conclusions: Anteverting periacetabular osteotomy for acetabular retroversion leads to favorable long-term results with preservation of the native hip at a mean of ten years. Overcorrection resulting in excessive anteversion of the hip and omitting concomitant offset creation of the femoral head-neck junction are associated with an unfavorable outcome.

Level of Evidence: Therapeutic Level IV. See instructions for Authors for a complete description of levels of evidence.

1Department of Orthopedic Surgery, Inselspital Bern, University of Bern, 3010 Bern, Switzerland. E-mail address for K.A. Siebenrock: klaus.siebenrock@insel.ch

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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