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Prevalence and treatment of intraarticular pathology recognized at the time of periacetabular osteotomy for the dysplastic hip.

Abstract：

BACKGROUND:The indication for hip arthrotomy accompanied by intraarticular work during periacetabular osteotomy (PAO) has not been precisely defined. To validate a role for routine hip arthrotomy accompanied by intraarticular work, frequent intraarticular pathology must exist, and the adjunct procedures must not be associated with inferior relief of pain, reduced function, radiographic osteoarthritis progression, or conversion to THA. QUESTIONS/PURPOSES:(1) What is the prevalence of intraarticular pathology at the time of PAO? (2) Does concomitant hip arthrotomy with associated intraarticular work negatively affect PAO as reflected by differences in Harris hip scores (HHS), Tönnis grade, and failure rates? METHODS:We retrospectively reviewed the intraarticular findings in all 151 patients who underwent PAO accompanied by routine hip arthrotomy and intraarticular work from 2002 to 2009. Using multivariate regression models, we compared the HHS and Tönnis grades of patients receiving arthrotomy with a cohort of 39 patients who received PAO alone. RESULTS:The overall prevalence of intraarticular pathology identified during PAO was 89%. Eight (5.3%) failures were identified within the arthrotomy cohort with mean postoperative HHS, postoperative Tönnis grade, postoperative change in HHS, and postoperative change in Tönnis grade of 87.5, 0.7, 29.8, and 0.3, respectively. By contrast, seven (17.9%) failures were identified in the nonarthrotomy cohort. The mean postoperative HHS, postoperative Tönnis grade, postoperative change in HHS, and postoperative change in Tönnis grade for the nonarthrotomy cohort were 83.1, 1.3, 19.0, and 0.3, respectively. CONCLUSIONS:We believe the high prevalence of intraarticular pathology is sufficient to warrant routine joint inspection at the time of PAO. Hip arthrotomy accompanied by intraarticular work at the time of PAO is safe and does not impose additional patient morbidity. LEVEL OF EVIDENCE:Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

journal_name

Clin Orthop Relat Res

journal_title

Clinical orthopaedics and related research

authors

Ginnetti JG,Pelt CE,Erickson JA,Van Dine C,Peters CL

doi

10.1007/s11999-012-2602-2

subject

Has Abstract

pub_date

2013-02-01 00:00:00

pages

498-503

issue

eissn

0009-921X

issn

1528-1132

journal_volume

471

pub_type

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Prevalence and treatment of intraarticular pathology recognized at the time of periacetabular osteotomy for the dysplastic hip.