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Clinical Outcomes According to Femoral and Acetabular Version After Periacetabular Osteotomy

Seo, Hajime, MD, PhDa,1; Naito, Masatoshi, MD, PhD2; Kinoshita, Koichi, MD, PhD1; Minamikawa, Tomohiko, MD, PhD1; Yamamoto, Takuaki, MD, PhD1

doi: 10.2106/JBJS.OA.17.00048
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Background: Patients with acetabular dysplasia often have abnormal femoral and acetabular version. The effect of combined femoral and acetabular version on clinical outcomes after periacetabular osteotomy for the treatment of acetabular dysplasia remains unclear. The purposes of the present study were (1) to evaluate the association of combined femoral and acetabular version with clinical outcome after periacetabular osteotomy and (2) to investigate the association of femoral version independently with clinical outcome after periacetabular osteotomy.

Methods: We retrospectively reviewed the records for 92 consecutive patients (95 hips) who had undergone periacetabular osteotomy for the treatment of symptomatic acetabular dysplasia. The patient cohort comprised 85 females and 7 males with a mean age of 38.9 years at the time of surgery. The mean duration of follow-up was 4.8 years (range, 2.0 to 7.2 years). Femoral and acetabular version and the alpha angle were measured on postoperative computed tomography scans. Clinical outcomes included range of motion and the modified Harris hip score. Analysis of variance was used to investigate the effect of femoral version on clinical outcomes. Analysis of covariance was used to adjust for potential covariates.

Results: Combined femoral and acetabular version after periacetabular osteotomy was slightly, but significantly, correlated with postoperative flexion (r = 0.222; p = 0.031) and internal rotation in flexion (r = 0.326; p = 0.001). Patients with mild femoral version (<15°) experienced significantly less postoperative internal rotation in flexion than those with severe femoral version (>35°); however, this difference was lost after adjustment for potential covariates. There were no differences among femoral version groups (mild, moderate, and severe) in terms of improvements in the clinical outcomes of pain, function, and activity.

Conclusions: Combined femoral and acetabular version after periacetabular osteotomy was significantly correlated with postoperative range of motion. Abnormality of femoral version associated with acetabular dysplasia did not demonstrate any effect on the clinical outcomes of periacetabular osteotomy.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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1Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan

2Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan

E-mail address for H. Seo:

Investigation performed at the Department of Orthopaedic Surgery, Fukuoka University, Fukuoka, Japan

Disclosure: There was no external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.