Combined periacetabular and femoral osteotomies for severe hip deformities

Abstract

Periacetabular osteotomy (PAO) is an effective acetabular reorientation technique for treatment of symptomatic acetabular dysplasia. In hips with severe deformities, an adjunctive femoral osteotomy (PFO) may optimize correction, joint stability, and congruency. We analyzed the clinical and radiographic results of combined PAO/PFO in treating severe hip deformities. Second, we compared the clinical results of patients treated with PAO/PFO with patients treated with isolated PAO for lesser deformities. Twenty-five patients (28 hips) treated with PAO/PFO were reviewed and followed a minimum of 16 months (mean, 44 months). The matched PAO cohort included 25 patients (28 hips). For the PAO/PFO group, the average Harris hip score improved from 60.9 to 86.3. Eighty-nine percent of the patients demonstrated at least a 10-point improvement in the hip score and 75% had a Harris hip score over 80 points. Radiographic evaluation demonstrated consistent deformity correction. The PAO/PFO group had a lower average Harris hip score preoperatively, yet hip function after surgery was comparable between groups. These data indicate combined PAO/PFO is associated with improved hip function in most patients. These clinical results are comparable to those obtained with isolated PAO for lesser hip deformities.

Fig. 1A–B

Anteroposterior pelvic radiographs of an 11-year-old girl with severe bilateral hip dysplasia are shown. In addition to major acetabular deficiency, she has (A) severe bilateral coxa valga. She was treated with (B) sequential bilateral periacetabular osteotomies and combined varus-producing proximal femoral osteotomies. She had an excellent clinical result bilaterally.

Fig. 2A–B

Anteroposterior pelvic views of a 20-year-old woman with a symptomatic Perthes-like deformity of the right hip (A), including moderate acetabular dysplasia, a large aspheric femoral head, short femoral neck, and relatively high greater trochanter. This patient was managed with a combined periacetabular osteotomy and valgus-producing proximal femoral osteotomy (B). The proximal femoral osteotomy was performed to optimize congruency, advance the trochanter distally, improve clinical abduction motion, and lengthen the extremity. The patient has an excellent clinical result 4 years after surgery.

Fig. 3A–E

A failed combined PAO/PFO in a 44 year-old man is shown. (A) This patient had a Perthes-like deformity of the left hip with severe superolateral inclination of the acetabular articular cartilage, an aspherical femoral head, short, wide femoral neck, and relatively high greater trochanter. (B) The patient also had severe lack of femoral head coverage anteriorly. (C) This patient was treated with a combined periacetabular osteotomy (PAO) and proximal femoral valgus osteotomy (PFO). (D) The patient had improved hip function for 5 years and then had rapid deterioration of the hip joint associated with severe radiographic osteoarthritis. (E) At 5½ years after the initial surgery, the patient was treated with THA.