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Periacetabular Osteotomy In The Athletic Middle-Aged Patient: An Outcomes Study On Patients Aged 45 Years And Older


Matthew J. Kraeutler, MD
UNITED STATES

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Periacetabular Osteotomy In The Athletic Middle-Aged Patient: An Outcomes Study On Patients Aged 45 Years And Older

Jessica H Lee, MD, UNITED STATES Matthew J. Kraeutler, MD, UNITED STATES Omer Mei-Dan, MD, UNITED STATES

University of Colorado School of Medicine, Boulder, CO, UNITED STATES

2023 Congress   ePoster Presentation   2023 Congress   Not yet rated

 

Anatomic Location

Hip / Groin / Thigh

Anatomic Structure

Bones Cartilage

Diagnosis / Condition

Instability

Treatment / Technique

Osteotomy

Summary: This study demonstrates that older cohorts can benefit from periacetabular osteotomy (PAO) and that age alone should not be considered a contraindication for PAO.

Background

Previous long-term studies on periacetabular osteotomy (PAO) outcomes have associated increased age with less favorable clinical results and a higher failure rate. Therefore, surgeon hesitancy to perform PAO surgery in an older cohort has resulted in the implementation of age cutoffs for this population, leaving total hip arthroplasty (THA) as the singular surgical treatment option in a cohort that is active and generally considered too young for THA. The purpose of this study was to report on PAO outcomes in patients aged 45 years and older.

Methods

A retrospective case series of prospectively collected data was performed on patients with a minimum age of 45 years who underwent hip arthroscopy followed by a PAO by the senior author. Patients with follow-up less than 1 year were excluded. Pre- and postoperative patient-reported outcome scores (PROs) were obtained, including the International Hip Outcome Tool (iHOT-12) and Non-Arthritic Hip Score (NAHS). Additionally, hip internal rotation and flexion and radiographic measurements such as lateral center edge angle (LCEA) and Tönnis angle were obtained pre- and postoperatively and assessed for comparison.

Results

Thirty-five patients (40 hips) were included with a mean age of 49 years (range, 45-61 years) and average follow-up of 2.0 years (range, 1.0-5.0 years). Females accounted for 38 of the 40 hips (95%). Preoperative Tegner score averaged 6.1 (range, 4-9). LCEA increased from a mean 20 degrees (range, 9-29 degrees) preoperatively to a mean 33 degrees (range, 26-42 degrees) postoperatively (p < 0.0001). Tönnis angle decreased from a mean 12.0 degrees (range, 5-22 degrees) preoperatively to a mean -0.8 degrees (range, -11 to +11 degrees) postoperatively (p < 0.0001). iHOT-12 scores significantly increased from a mean 35.1 ± 14.5 preoperatively to 71.8 ± 27.2 at latest follow-up (p < 0.0001). NAHS scores significantly increased from a mean 58.1 ± 17.8 preoperatively to 76.9 ± 20.8 at latest follow-up (p < 0.001). One hip was converted to THA following PAO.

Conclusions

Active patients at least 45 years of age undergoing PAO for hip dysplasia yielded significantly improved outcomes in terms of patient-reported outcomes and radiographic measurements at early to mid-term follow-up. This study demonstrates that older cohorts can benefit from PAO surgery and that age alone should not be considered a contraindication for PAO.

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