Developmental dysplasia of the hip can cause pain and premature osteoarthritis. However, the risk factors and timing for disease progression in young adults are not fully defined. This study identified the incidence and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on an index dysplastic hip. Patients followed for 2+ years after unilateral PAO were grouped by eventual contralateral pain or no-pain, based on modified Harris Hip Score, and surgery or no-surgery. Univariate analysis tested group differences in demographics, radiographic measures, and range-of-motion. Kaplan-Meier survival analysis assessed pain development and contralateral hip surgery over time. Multivariate regression identified pain and surgery risk factors. Pain and surgery predictors were further analyzed in Dysplastic, Borderline, and Non-dysplastic subcategories, and in five-degree increments of lateral center edge angle (LCEA) and acetabular inclination (AI). 184 patients were followed for 4.6±1.6 years, during which 51% (93/184) reported hip pain and 33% (60/184) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% for pain development and 66% for contralateral surgery. Painful hips exhibited more severe dysplasia than no-pain hips (LCEA 16.5º vs 20.3º, p<0.001; AI 13.2º vs 10.0º p<0.001). AI was the sole predictor of pain, with every 1° AI increase raising the risk by 11%. Surgical hips also had more severe dysplasia (LCEA 14.9º vs 20.0º, p<0.001; AI 14.7º vs 10.2º p<0.001) and were younger (21.6 vs 24.1 years, p=0.022). AI and a maximum alpha angle ≥55° predicted contralateral surgery. 5 years after index hip PAO, 51% of contralateral hips experience pain and 34% percent are expected to need surgery. More severe dysplasia, based on LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning.
The purpose of the study was to determine access to and, ability to use telemedicine technology in an adult hip and knee reconstruction patient population and we seek to understand these patients' perceived benefits, risks and preferences of telemedicine. We performed a cross-sectional telephone administered survey on patients scheduled to undergo primary THA and TKA by one of six surgeons at a single academic institution between March 23 and June 2, 2020.Introduction
Methods
Utilizing radiographic, physical exam and history findings, we developed a novel clinical score to aid in the surgical decision making process for hips with borderline/ transitional dysplastic hips. Treatment of borderline acetabular dysplasia (BD) is controversial with some patients having primarily instability-based symptoms while others have impingement-based symptoms. The purpose of this study was to identify the most important patient characteristics influencing the diagnosis of instability vs. non-instability, develop a clinical score (Borderline Hip Instability Score, BHIS) to collectively characterize these factors and to externally validate BHIS in a multicenter cohort BD patients.Topic
Background
The aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities. Between 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle.Aims
Patients and Methods
The role for hip arthroscopy (HS) in combination with periacetabular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia has not been clearly defined. In this study, we assessed midterm outcomes of concurrent hip arthroscopy and PAO (HS/PAO) for the treatment of symptomatic acetabular dysplasia with associated intra-articular pathology. We performed a retrospective review of concurrent HS/PAO cases in a prospectively collected institutional hip preservation database. From November 2005 to December 2012, 85 hips in 80 patients underwent combined HS/PAO. Two hips had a diagnosis other than acetabular dysplasia and 12 hips were lost to follow up, leaving 71 hips for analysis at mean 6.6-year follow-up (range 4–11 years). Hips were evaluated using the University of California, Los Angeles (UCLA) Activity Score, modified Harris Hip Score (mHHS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore. Hips were stratified into preserved or failed groups, with failure defined as conversion to THA or a symptomatic hip (mHHS <70 or WOMAC pain subscore > 10). Complications were recorded and graded by the Clavien-Dindo classification. Regression analyses were performed to identify the interaction between patient factors, radiographic measures, and surgical details with outcome.Introduction
Methods
Acetabular dysplasia is associated with an increased risk of hip pain and early development of osteoarthritis (OA). The Bernese peri-acetabular osteotomy (PAO) is the most well-established technique in the Western world for the treatment of symptomatic acetabular dysplasia. This case-control study aims to assess whether the severity of acetabular dysplasia has an effect on outcome following Peri-Acetabular Osteotomy (PAO) and/or the ability to achieve desired acetabular correction. A prospective, multicentre, longitudinal cohort of consecutive PAOs was reviewed. Of the available 381 cases, 61 hips had pre-PAO radiographic features of lesser-dysplasia [Acetabular-Index (AI)<15° and Lateral-Centre-Edge-Angle (LCEA)>15°) and comprised the ‘study-group’. ‘Study-Group’ was matched for all factors known to influence outcome post-PAO [age, gender, BMI, Tönnis-grade and joint congruency (p=0.6–0.9)] with a ‘Comparison-Group’ of pronounced dysplasia (n=183). Clinical outcomes, complications and the ability to achieve optimum correction (LCEA: 25°–40°/AI: 0°–+10°) were compared.Introduction
Patients/Materials & Methods
