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Chirurgia 2022 February;35(1):24-30

DOI: 10.23736/S0394-9508.21.05262-1


language: English

Improvement in clinical and radiological scores after Bernese periacetabular osteotomy does not stop radiological osteoarthritis progression

Mehmet B. EREN 1 , Erkal BİLGİÇ 1, Murat AŞÇI 2, Bora BOSTAN 3, Taner GÜNEŞ 2

1 Department of Orthopedics and Traumatology, Gaziosmanpasa University Hospital, Tokat, Turkey; 2 Department of Orthopedics and Traumatology, Eskişehir Hospital, Acıbadem University, Eskişehir, Turkey; 3 Department of Orthopedics and Traumatology, Medical Palace Hospital, Kayseri, Turkey

BACKGROUND: Neonatal instability of the hip that does not spontaneous resolve causes subluxation, dysplasia or dislocation. Reduced coverage of the femoral head due to acetabular dysplasia leads to increased weight bearing on the shallow acetabulum. Bernese periacetabular osteotomy was developed by Ganz et al. based on cadaver and bone models and was among the surgical practices in 1984. The awareness of the technique has increased following the encouraging early results published in 1988. We have performed this procedure 30 times at our institution. In this investigation, we asked ourselves: 1) can osteoarthritis modifications continue despite biomechanical improvements?; 2) did clinical scores improve after surgery?; 3) did we achieve adequate biomechanical correction and femoral head coverage? Our working hypothesis was: “the biomechanical effect of periacetabular osteotomy cannot stop radiological osteoarthritis progression.”
METHODS: Between June 2005 and July 2014 we have performed 30 PAO (30 hips from 24 patients). We have clinically assessed the 24 patients (30 hips) at last follow-up with the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form Survey-36 (SF-36). Plain radiographic evaluation was performed preoperatively and at the last follow-up. Preoperative and early postoperative CT was performed. Radiographical parameters were recorded preoperatively and at the latest postoperative follow-up. Osteoarthritis was graded according to Tönnis Classification preoperatively and postoperatively.
RESULTS: Postoperative change in Tönnis Classification was significant (P<0.001). Changes in the acetabular index, HHS, sharp angle, CEA and anterior CEA were significant (P<0.001).
CONCLUSIONS: Supporting our working hypothesis, progress in osteoarthritis scores continued, with improvement in clinical and radiological scores. Arthrosis may continue to progress insidiously after periacetabular osteotomy. Studies involving a larger number of cases and control groups investigating the development of osteoarthritis after periacetabular osteotomy are needed.

KEY WORDS: Congenital hip dislocation; Osteotomy; Developmental dysplasia of the hip

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