Abstract
BackgroundBernese periacetabular osteotomy (PAO) is an effective treatment for patients with developmental dysplasia of the hip (DDH). PAO has been widely used in China, but few follow-up outcomes have been reported in the international community. Moreover, the risk factors affecting patient-reported outcomes have not been discussed in recent studies. In this study, patient-reported outcomes after PAO were reported, and risk factors affecting patient-reported outcomes were analyzed.MethodsPatients who underwent PAO for DDH from January 2014 to January 2020 were selected as the study subjects, and 66 hips were included in the analysis after screening (59 patients, with an average follow-up time of 3.01 years). The Harris Hip Score (HHS) and International Hip Outcome Instrument-12 (iHOT-12) were used to assess hip function and patient quality of life. The changes of preoperative and latest follow-up HHSs less than 9 were defined as symptomatic hips, that is, an adverse outcome; otherwise, the score indicates preserved hips. Also, the changes of preoperative and latest follow-up iHOT-12 were defined as symptomatic hips and preserved hips. Multivariate logistic regression analysis was used to predict the risk factors influencing the patient-reported outcomes, and receiver operating characteristic (ROC) curve analysis was performed on the risk factors to determine their sensitivity, specificity and cutoff value.ResultsClinical outcome analysis demonstrates marked improvements in patient-reported outcomes. The multivariate logistic regression analysis showed that when the postoperative LCEA was > 38°, adverse outcomes were much more likely. However, a Tönnis angle of − 10° to 0° was a protective factor. In addition, hips with fair or poor joint congruency were more likely to develop negative outcomes. The ROC curve analysis showed that the optimal thresholds for the LCEA and Tönnis angles used to predict outcomes after PAO were 38.2° and − 9°, respectively. Based on the results of the ROC curve analysis, among hips with poor or fair joint congruency preoperatively treated by surgeons who obtained the improper postoperative LCEAs and Tönnis angles, bad patient-reported outcomes will most likely be obtained.ConclusionsOur results demonstrate marked improvements in patient-reported outcomes. Among hips with preoperative excellent or good joint congruency treated by experienced surgeons who obtain the proper postoperative LCEA and Tönnis angles, good patient-reported outcomes can be expected.
Highlights
Developmental dysplasia of the hip (DDH) refers to inadequate coverage of the femoral head by the acetabulum due to abnormal structural development of the hip, which leads to subluxation or complete dislocation of the hip [1, 2]
Among hips with preoperative excellent or good joint congruency treated by experienced surgeons who obtain the proper postoperative lateral center-to-edge angle (LCEA) and Tönnis angles, good patient-reported outcomes can be expected
The patients reported a mean improvement from a 61.00 ± 16.16 preoperatively to a 80.65 ± 7.14 at the last follow-up (p < 0.001) on the Harris Hip Score (HHS) scale and from 60.94 ± 22.41 to 87.11 ± 19.98 (p < 0.001) on the International Hip Outcome Tool12 (iHOT-12) scale (Table 1)
Summary
Developmental dysplasia of the hip (DDH) refers to inadequate coverage of the femoral head by the acetabulum due to abnormal structural development of the hip, which leads to subluxation or complete dislocation of the hip [1, 2]. PAO corrects the lateral, anterior coverage, forward and backward tilt, and inward and outward displacement of the acetabulum and ensures continuity of the posterior column of the pelvis and provides satisfactory correction of the acetabulum in DDH patients, thereby delaying hip osteoarthritis and total hip arthroplasty (THA), rendering it fully applicable to young patients [4] This surgery has been widely used in many countries, and some follow-up results have confirmed the efficacy of PAO [5,6,7,8,9,10,11,12,13,14,15,16,17]. Patient-reported outcomes after PAO were reported, and risk factors affecting patientreported outcomes were analyzed
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