Intermediate to Long-Term Results Following the Bernese Periacetabular Osteotomy and Predictors of Clinical Outcome

Matheney, Travis; Young-Jo Kim; Zurakowski, David; Matero, Catherine; Millis, Michael
September 2010
Journal of Bone & Joint Surgery, American Volume;Sep2010 Supplement, p115
Academic Journal
BACKGROUND: The Bernese periacetabular osteotomy is a commonly used non-arthroplasty option to treat developmental hip dysplasia in symptomatic younger patients. Predicting which hips will remain preserved and which hips will go on to require arthroplasty following periacetabular osteotomy is a major challenge. In the present study, we assessed the intermediate to long-term results following periacetabular osteotomy to demonstrate the clinical outcomes for patients with varying amounts of dysplasia and arthritis. From these results, a probability-of-failure analysis was conducted to predict the likelihood of hip preservation and to improve surgical decision-making. METHODS: Of the 189 hips (in 157 patients) that were treated with periacetabular osteotomy by a single surgeon from May 1991 to September 1998, thirty-one had diagnoses other than developmental hip dysplasia and twenty-three were lost to follow-up. The remaining 135 hips (in 109 patients) were retrospectively reviewed at an average of nine years. Hips were evaluated with use of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index postoperatively as well as with radiographs that were made preoperatively and at one and more than five years postoperatively. Osteotomy failure was defined as a pain score of ≥10 or the need for total hip arthroplasty. RESULTS: One hundred and two hips (76%) remained preserved at an average of nine years, with an average Western Ontario and McMaster Universities pain score of 2.4 of 20. Thirty-three hips (24%) met the failure criteria: seventeen underwent arthroplasty at an average of 6.1 years after the osteotomy, and sixteen had a postoperative pain score of ≥10. Kaplan-Meier analysis with arthroplasty as the end point revealed a survival rate of 96% (95% confidence interval, 93% to 99%) at five years and 84% (95% confidence interval, 77% to 90%) at ten years. Complications occurred in twenty hips. Fifteen hips (11%) were treated with a subsequent arthroscopy because of chondral and/or labral lesions at an average of 6.8 years after the osteotomy. Two independent predictors of failure (defined as arthroplasty or a high pain score) were identified: (1) an age of more than thirty-five years and (2) poor or fair preoperative joint congruency. The probability of failure requiring arthroplasty was 14% for hips with no predictors of failure, 36% for those with one predictor (either an age of more than thirty-five years or poor or fair joint congruency), and 95% for those with both predictors. CONCLUSIONS: The Bernese periacetabular osteotomy can be effective for the treatment of painful hip dysplasia, but complications may be expected in as many as 15% of cases. The ideal candidate is the patient who is less than thirty-five years of age and who has good or excellent hip joint congruency. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Habitual dislocation of the hip: a rare case report. Mazhar, Farid Najd; Ghazavi, Mohammad Taghi; Gharanizadeh, Kaveh; Jafari, Davod // Medical Journal of the Islamic Republic of Iran;2014, Vol. 28, p1 

    Habitual dislocation of the hip (HDH) in children is a rare entity and can be a causative factor for popping or snapping hip which is a common problem in children with good prognosis. We report a case of HDH in a 9 year old girl who was suffering from frequent snapping hip at night, its course...

  • Anatomic total talar prosthesis replacement surgery and ankle arthroplasty: an early case series in Thailand. Chayanin Angthong // Orthopedic Reviews;2014, Vol. 6 Issue 3, p123 

    Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total...

  • Biggest ever hip fracture audit shows improvements in care, but significant geographical variations.  // Operating Theatre Journal;Oct2010, Issue 241, p3 

    The article discusses the report from the national hip fracture audit published on September 2, 2010, which reveals that NHS hip fracture patients are getting greater access to specialist care by geriatricians. It outlines the finding of the National Hip Fracture Database National Report 2010...

  • APPROCCIO ETNOIATRICO ALLA DISPLASIA CONGENITA DELL'ANCA. Capaldo, Gerardo // Scienza Riabilitativa;2009, Vol. 11 Issue 3, p15 

    Background The purpose of this study is to find possible connections between hip dysplasia in children and maternal care and handling. Methods The electronic literature searches were conducted by using PubMed; the paper ones at the Civic Library "Berio" in Genoa. The field research was based on...

  • Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast. Beek, Frederik; Nievelstein, Rutger-Jan; Pruijs, Hans; Jong, Pim; Sakkers, Ralph // Pediatric Radiology;Nov2010, Vol. 40 Issue 11, p1794 

    Background: Transinguinal sonography can be used to demonstrate the position of the femoral head after reduction of a dislocated hip. Objective: To determine whether transinguinal sonography can replace radiography and CT in the follow-up after reduction of a hip dislocation? Materials and...

  • Difference in time to x ray with similar time to treatment decision leads to differences in waiting times of patients with hip fracture in a crowded emergency department. Chia, W-T.; Chen, Y-S.; Lin, C-F. J.; Liu, H-H.; Lin, B-F. // Emergency Medicine Journal;May2008, Vol. 25 Issue 5, p274 

    The article discusses research done on the causes of waiting time by patients with hip fracture in the emergency department of an affiliated trauma center between January 2005 and January 2007. The study procedure included a review of emergency department records with such details as time to a...

  • Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience. Mladenović, Marko; Andjelković, Zoran; Micić, Ivan; Mladenović, Desimir; Stojiljković, Predrag; Milenković, Tanja // Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journ;Nov2015, Vol. 72 Issue 11, p1104 

    Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of...

  • Hip Dysplasia in the Skeletally Mature Patient. Goldstein, Rachel Y.; Kaye, Ian David; Slover, James; Feldman, David // Bulletin of the Hospital for Joint Diseases;2014, Vol. 72 Issue 1, p28 

    Abnormal hip development causes one-quarter to one-half of all hip disease. Dysplastic hips typically share characteristic anatomic abnormalities. The dysplastic acetabidum is typi-cally shallow, lateralized, and anteverted with insufficient coverage anteriorly, superiorly, and laterally. The...

  • Comparison of 2.5D and 3D Quantification of Femoral Head Coverage in Normal Control Subjects and Patients with Hip Dysplasia. Cheng, Hui; Liu, Li; Yu, Weimin; Zhang, Hong; Luo, Dianzhong; Zheng, Guoyan // PLoS ONE;11/24/2015, Vol. 10 Issue 11, p1 

    Hip dysplasia is characterized by insufficient femoral head coverage (FHC). Quantification of FHC is of importance as the underlying goal of the surgery to treat hip dysplasia is to restore a normal acetabular morphology and thereby to improve FHC. Unlike a pure 2D X-ray radiograph-based...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics