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Hüftdysplasie im Grenzbereich: Welchen Einfluss haben Alter, Arthrose und Begleiterkrankungen auf das Behandlungsergebnis?

Hip dysplasia: What influence do age, arthrosis and concomitant diseases have on the treatment result?

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Zusammenfassung

Die Beckenosteotomie ist eine etablierte Therapie der symptomatischen adulten Hüftdysplasie mit sehr guten Langzeitergebnissen. Neben der optimalen Reorientierung des Pfannendaches sind die Resultate auch durch patientenabhängige Faktoren, wie den präoperativen Gelenkzustand (v. a. Gelenkkongruenz und Ausmaß degenerativer Veränderungen) sowie das Alter, beeinflusst. Zusätzlich ist die Identifikation und Therapie von impingementassoziierten Hüftpathologien entscheidend, um den mittel- bis langfristigen Verlauf positiv zu beeinflussen. Die Auswirkung von Schäden des chondrolabralen Komplexes sind noch nicht ausreichend beleuchtet. Auch symptomatische Patient*innen mit Restdysplasie nach vorheriger Osteotomie am Becken oder Femur können von einer Beckenosteotomie profitieren, selbst wenn sich Voreingriffe nachteilig auf das Ergebnis auswirken können. Übergewicht kann das intraoperative Komplikationsrisiko erhöhen, zeigt bis jetzt aber keinen Einfluss auf den postoperativen Verlauf. Insgesamt sollten die eine Indikationsstellung beeinflussenden Faktoren nicht isoliert, sondern in Summe betrachtet werden.

Abstract

Pelvic osteotomies are an established treatment for symptomatic adult hip dysplasia with a promising long-term outcome. Results depend not only on the achieved acetabular reorientation but also on patient-factors like preoperative joint condition (degree of osteoarthritis and joint congruency) and age. Additionally, the diagnosis and appropriate therapy of impingement-associated hip deformities is essential in order to achieve good mid- and long-term outcomes. The influence of chondrolabral pathology on the outcome of pelvic osteotomies is not yet defined. Symptomatic patients with residual dysplasia after previous pelvic or acetabular osteotomies can benefit from an additional osteotomy, although results can be worse in comparison to prior unoperated joints. Obesity can make surgery more demanding and increases the complication profile of PAO, although it has no influence on the postoperative outcome. Regarding the overall prognosis after an osteotomy, the consideration of combined risk factors is superior to the concentration on individual factors alone.

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Abbreviations

BMI:

Body-Mass-Index

CE-Winkel :

Centrum-Erker-Winkel

GTO :

Global Treatment Outcome Score

HOOS :

Hip Disability and Osteoarthritis Outcome Score

mHHS :

Modified Harris Hip Score

PAO :

Periazetabuläre Osteotomie

PROM :

Patient-Reported Outcome Measures

THA :

Totaler Hüftgelenkersatz

UCLA :

University of California Los Angeles

VAS :

Visuelle Analogskala

WOMAC :

Western Ontario and McMaster Universities Osteoarthritis Index

Literatur

  1. Lerch TD, Steppacher SD, Liechti EF, Tannast M, Siebenrock KA (2017) One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res 475(4):1154–1168

    Article  PubMed  Google Scholar 

  2. Ahmad SS, Giebel GM, Perka C, Meller S, Pumberger M, Hardt S et al (2021) Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis. Hip Int. https://doi.org/10.1177/11207000211048425

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wyles CC, Vargas JS, Heidenreich MJ, Mara KC, Peters CL, Clohisy JC et al (2019) Natural history of the ysplastic hip following modern periacetabular osteotomy. J Bone Joint Surg Am 101(10):932–938

    Article  PubMed  Google Scholar 

  4. Wells J, Millis M, Kim Y‑J, Bulat E, Miller P, Matheney T (2017) Survivorship of the Bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res 475(2):396–405

    Article  PubMed  Google Scholar 

  5. Hamai S, Kohno Y, Hara D, Shiomoto K, Akiyama M, Fukushi JI, Motomura G, Ikemura S, Fujii MNY (2018) Minimum 10-year clinical outcomes after periacetabular osteotomy for advanced osteoarthritis due to hip dysplasia. Orthopedics 41(5):300–305

    Article  PubMed  Google Scholar 

  6. Teratani T, Naito M, Kiyama T, Maeyama A (2010) Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am 92(1):31–41

    Article  PubMed  Google Scholar 

  7. Yasunaga Y, Fujii J, Tanaka R, Yasuhara S, Yamasaki T, Adachi N et al (2017) Rotational acetabular osteotomy. Clin Orthop Surg 9(2):129. https://doi.org/10.4055/cios.2017.9.2.129

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yasunaga Y, Ochi M, Yamasaki T, Shoji T, Izumi S (2016) Rotational acetabular osteotomy for pre- and early osteoarthritis secondary to dysplasia provides durable results at 20 years. Clin Orthop Relat Res 474(10):2145–2153

    Article  PubMed  PubMed Central  Google Scholar 

  9. Clohisy JC, Ackerman J, Baca G, Baty J, Beaule PE, Kim YJ et al (2017) Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study. J Bone Joint Surg Am 99(1):33–41

    Article  PubMed  PubMed Central  Google Scholar 

  10. McClincy MP, Wylie JD, Kim YJ, Millis MB, Novais EN (2019) Periacetabular osteotomy improves pain and function in patients with lateral center-edge angle between 18° and 25°, but are these hips really borderline dysplastic? Clin Orthop Relat Res 477(5):1145–1153

    Article  PubMed  Google Scholar 

  11. De La Rocha A, Sucato DJ, Tulchin K, Podeszwa DA (2012) Treatment of adolescents with a periacetabular osteotomy after previous pelvic surgery hip. Clin Orthop Relat Res 470(9):2583–2590

    Article  PubMed  PubMed Central  Google Scholar 

  12. Polkowski GG, Novais EN, Kim YJ, Millis MB, Schoenecker PL, Clohisy JC (2012) Does previous reconstructive surgery influence functional improvement and deformity correction after periacetabular osteotomy? Clin Orthop Relat Res 470(2):516–524

    Article  PubMed  Google Scholar 

  13. Stambough JB, Clohisy JC, Baca GR, Zaltz I, Trousdale R, Millis M et al (2015) Does previous pelvic osteotomy compromise the results of periacetabular osteotomy surgery? Clin Orthop Relat Res 473(4):1417–1424

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mayo KA, Trumble SJ, Mast JW (1999) Results of periacetabular osteotomy in patients with previous surgery for hip dysplasia. Clin Orthop Relat Res 363:73–80

    Article  Google Scholar 

  15. Clohisy JC, Nunley RM, Carlisle JC, Schoenecker PL (2009) Incidence and characteristics of femoral deformities in the dysplastic hip. Clin Orthop Relat Res 467(1):128–134

    Article  PubMed  Google Scholar 

  16. Domb BG, Lareau JM, Baydoun H, Botser I, Millis MB, Yen Y‑M (2014) Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy? Clin Orthop Relat Res 472(2):674–680. https://doi.org/10.1007/s11999-013-3140-2

    Article  PubMed  Google Scholar 

  17. Scott EJ, Thomas-Aitken HD, Glass N, Westermann R, Goetz JE, Willey MC (2018) Unaddressed cam deformity is associated with elevated joint contact stress after periacetabular osteotomy. J Bone Joint Surg Am 100(20):e131

    Article  PubMed  Google Scholar 

  18. Albers CE, Steppacher SD, Ganz R, Tannast M, Siebenrock KA (2013) Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH hip. Clin Orthop Relat Res 471(5):1602–1614

    Article  PubMed  PubMed Central  Google Scholar 

  19. Goronzy J, Franken L, Hartmann A, Thielemann F, Postler A, Paulus T et al (2017) What are the results of surgical treatment of hip dysplasia with concomitant cam deformity? Clin Orthop Relat Res 475(4):1128–1137

    Article  PubMed  Google Scholar 

  20. Fujii M, Nakashima Y, Jingushi S, Yamamoto T, Noguchi Y, Suenaga E et al (2009) Intraarticular findings in symptomatic developmental dysplasia of the hip. J Pediatr Orthop 29(1):9–13

    Article  PubMed  Google Scholar 

  21. Ross JR, Zaltz I, Nepple JJ, Schoenecker PL, Clohisy JC (2011) Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia. Am J Sports Med 39(1):72–78. https://doi.org/10.1177/0363546511412320

    Article  Google Scholar 

  22. McCarthy JC, Lee J (2002) Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res 405:122–128

    Article  Google Scholar 

  23. Lara J, Garín A, Herrera C, Abara S, Besomi J, Villegas D et al (2020) Bernese periacetabular osteotomy: functional outcomes in patients with untreated intra-articular lesions. J Hip Preserv Surg 7(2):256–261

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hagio T, Naito M, Nakamura Y, Muraoka K (2016) Do labral tears influence poor outcomes after periacetabular osteotomy for acetabular dysplasia? Bone Joint J 98(6):741–746. https://doi.org/10.1302/0301-620X.98B6.36034

    Article  PubMed  Google Scholar 

  25. Cvetanovich GL, Heyworth BE, Murray K, Yen Y‑M, Kocher MS, Millis MB (2015) Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes. J Hip Preserv Surg 2(3):295–302. https://doi.org/10.1093/jhps/hnv037

    Article  PubMed  PubMed Central  Google Scholar 

  26. Laboudie P, Dymond T, Kreviazuk C, Grammatopoulos G, Beaulé PE (2022) Hip arthroscopy after periacetabular osteotomy for acetabular dysplasia—incidence and clinical outcome. BMC Musculoskelet Disord 23(1):659. https://doi.org/10.1186/s12891-022-05625-x

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hartig-Andreasen C, Troelsen A, Thillemann TM, Gelineck J, Søballe K (2015) Risk factors for the need of hip arthroscopy following periacetabular osteotomy. J Hip Preserv Surg. https://doi.org/10.1093/jhps/hnv053

    Article  PubMed  PubMed Central  Google Scholar 

  28. Curley AJ, Engler ID, Ruh ER, Mauro CS, McClincy MP (2022) Periacetabular osteotomy after failed hip arthroscopy demonstrates improved outcomes in a heterogenous patient population: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07108-x

    Article  PubMed  Google Scholar 

  29. Matheney T, Kim Y‑J, Zurakowski D, Matero C, Millis M (2010) Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am 92:115–129

    Article  PubMed  Google Scholar 

  30. Hartig-Andreasen C, Nielsen TG, Lund B, Søballe K, Lind M (2017) Outcome after arthroscopic labral surgery in patients previously treated with periacetabular osteotomy: a follow-up study of 43 patients. J Hip Preserv Surg 4(1):67–73. https://doi.org/10.1093/jhps/hnx002

    Article  PubMed  PubMed Central  Google Scholar 

  31. Atzmon R, Safran MR (2022) Arthroscopic treatment of mild/borderline hip dysplasia with concomitant femoroacetabular impingement—literature review. Curr Rev Musculoskelet Med 15(4):300–310. https://doi.org/10.1007/s12178-022-09765-4

    Article  PubMed  PubMed Central  Google Scholar 

  32. Murata Y, Fukase N, Martin M, Soares R, Pierpoint L, Dornan GJ et al (2021) Comparison between hip arthroscopic surgery and periacetabular osteotomy for the treatment of patients with borderline developmental dysplasia of the hip: a systematic review. Orthop J Sports Med 9(5):232596712110074. https://doi.org/10.1177/23259671211007401

    Article  Google Scholar 

  33. Ricciardi BF, Fields KG, Wentzel C, Kelly BT, Sink EL (2017) Early functional outcomes of periacetabular osteotomy after failed hip arthroscopic surgery for symptomatic acetabular dysplasia. Am J Sports Med 45(11):2460–2467. https://doi.org/10.1177/0363546517710011

    Article  PubMed  Google Scholar 

  34. Gosey GM, Muldoon MP, Healey RM, Santore RF (2018) Operative findings and complications associated with adjunctive hip arthroscopy in 95 hips undergoing periacetabular osteotomy. Hip Int 28(3):278–283. https://doi.org/10.5301/hipint.5000564

    Article  PubMed  Google Scholar 

  35. Ricciardi BF, Mayer SW, Fields KG, Wentzel C, Kelly BT, Sink EL (2016) Patient characteristics and early functional outcomes of combined arthroscopic labral refixation and periacetabular osteotomy for symptomatic acetabular dysplasia. Am J Sports Med 44(10):2518–2525. https://doi.org/10.1177/0363546516651829

    Article  PubMed  Google Scholar 

  36. Thanacharoenpanich S, Boyle MJ, Murphy RF, Miller PE, Millis MB, Kim Y‑J et al (2018) Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required? J Hip Preserv Surg 5(1):23–33

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wyles CC, Hevesi M, Bartels DW, Larson DR, Sierra RJ, Trousdale RT (2018) Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes. J Hip Preserv Surg 5(3):282–295

    Article  PubMed  PubMed Central  Google Scholar 

  38. Matheney T, Kim Y‑J, Zurakowski D, Matero C, Millis M (2009) Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am 91(9):2113–2123

    Article  PubMed  Google Scholar 

  39. Hartig-Andreasen C, Troelsen A, Thillemann TM, Søballe K (2012) What factors predict failure 4 to 12 years after periacetabular osteotomy? Clin Orthop Relat Res 470(11):2978–2987. https://doi.org/10.1007/s11999-012-2386-4

    Article  PubMed  PubMed Central  Google Scholar 

  40. Steppacher SD, Tannast M, Ganz R, Siebenrock KA (2008) Mean 20-year followup of bernese periacetabular osteotomy. Clin Orthop Relat Res 466(7):1633–1644

    Article  PubMed  PubMed Central  Google Scholar 

  41. Okano K, Enomoto H, Osaki M, Shindo H (2008) Outcome of rotational acetabular osteotomy for early hip osteoarthritis secondary to dysplasia related to femoral head shape: 49 hips followed for 10–17 years. Acta Orthop 79(1):12–17. https://doi.org/10.1080/17453670710014699

    Article  PubMed  Google Scholar 

  42. Millis MB, Kain M, Sierra R, Trousdale R, Taunton MJ, Kim YJ et al (2009) Periacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study. Clin Orthop Relat Res 467(9):2228–2234

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ziran N, Varcadipane J, Kadri O, Ussef N, Kanim L, Foster A et al (2019) Ten- and 20-year survivorship of the hip after periacetabular osteotomy for acetabular dysplasia. J Am Acad Orthop Surg 27(7):247–255

    Article  PubMed  Google Scholar 

  44. Beaulé PE, Dowding C, Parker G, Ryu JJ (2014) What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy? Clin Orthop Relat Res 473(2):615–622

    Article  PubMed Central  Google Scholar 

  45. Mori R, Yasunaga Y, Yamasaki T, Nakashiro J, Fujii J, Terayama H et al (2014) Are cam and pincer deformities as common as dysplasia in Japanese patients with hip pain? Bone Joint J 96(2):172–176

    Article  PubMed  Google Scholar 

  46. Khan OH, Malviya A, Subramanian P, Agolley D, Witt JD (2017) Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach. Bone Joint J 99(1):22–28. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0439.R1

    Article  PubMed  Google Scholar 

  47. Franken L, Thielemann F, Postler A, Blum S, Hartmann A, Günther K‑P et al (2018) Periazetabuläre Osteotomie – Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse? Orthopade 47(3):228–237. https://doi.org/10.1007/s00132-017-3523-2

    Article  CAS  PubMed  Google Scholar 

  48. Petrie JR, Novais EN, An TW, Clohisy J, Schoenecker PL, Zaltz I et al (2020) What is the impact of periacetabular osteotomy surgery on patient function and activity levels? J Arthroplasty 35(6):S113–8

    Article  PubMed  Google Scholar 

  49. Muffly BT, Zacharias AJ, Jochimsen KN, Duncan ST, Jacobs CA, Clohisy JC (2021) Age at the time of surgery is not predictive of early patient-reported outcomes after periacetabular osteotomy. J Arthroplasty 36(10):3388–3391

    Article  PubMed  Google Scholar 

  50. Stiehler M, Goronzy J, Günther K‑P (2015) Die endoprothetische Versorgung beim übergewichtigen Koxarthrosepatienten. Orthopade 44(7):523–530. https://doi.org/10.1007/s00132-015-3094-z

    Article  CAS  PubMed  Google Scholar 

  51. Salih S, Groen F, Hossein F, Witt J (2021) Hypermobility, age 40 years or older and BMI >30 kg m−2 increase the risk of complications following peri-acetabular osteotomy. J Hip Preserv Surg 7(3):511–517

    Article  Google Scholar 

  52. Novais EN, Potter GD, Clohisy JC, Millis MB, Kim YJ, Trousdale RT et al (2015) Obesity is a major risk factor for the development of complications after peri-acetabular osteotomy. Bone Joint J 97(1):29–34. https://doi.org/10.1302/0301-620X.97B1.34014

    Article  PubMed  Google Scholar 

  53. Wylie JD, McClincy MP, Stieler EK, Millis MB, Kim Y‑J, Peters CL et al (2019) What factors affect fluoroscopy use during Bernese periacetabular osteotomy for acetabular dysplasia? J Hip Preserv Surg 6(3):259–264

    Article  PubMed  PubMed Central  Google Scholar 

  54. Dolan AL, Hart DJ, Doyle DV, Grahame R, Spector TD (2003) The relationship of joint hypermobility, bone mineral density, and osteoarthritis in the general population: the Chingford study. J Rheumatol 30(4):799–803

    PubMed  Google Scholar 

  55. Safran MR (2019) Microinstability of the hip—gaining acceptance. J Am Acad Orthop Surg 27(1):12–22

    Article  PubMed  Google Scholar 

  56. Birch S, Liljensøe A, Hartig-Andreasen C, Søballe K, Mechlenburg I (2015) No correlations between radiological angles and self-assessed quality of life in patients with hip dysplasia at 2–13 years of follow-up after periacetabular osteotomy. Acta Radiol 56(2):196–203

    Article  PubMed  Google Scholar 

  57. Fujita J, Doi N, Kinoshita K, Sakamoto T, Seo H, Yamamoto T (2022) Rate of return to work after periacetabular osteotomy and its influencing factors. J Bone Joint Surg Am 104(8):732–738. https://doi.org/10.2106/JBJS.21.00548

    Article  PubMed  Google Scholar 

  58. Murtha AS, Schmitz MR (2022) Periacetabular osteotomy in United States military personnel: results from an Interservice hip preservation practice. Orthop J Sports Med 10(2):1–6

    Article  Google Scholar 

  59. Ettinger M, Berger S, Floerkemeier T, Windhagen H, Ezechieli M (2015) Sports activity after treatment of residual hip dysplasia with triple pelvic osteotomy using the tönnis and kalchschmidt technique. Am J Sports Med 43(3):715–720

    Article  PubMed  Google Scholar 

  60. Hara D, Hamai S, Fukushi J, Kawaguchi K, Motomura G, Ikemura S et al (2017) Does participation in sports affect osteoarthritic progression after periacetabular osteotomy? Am J Sports Med 45(11):2468–2475. https://doi.org/10.1177/0363546517707942

    Article  PubMed  Google Scholar 

  61. Heyworth BE, Novais EN, Murray K, Cvetanovich G, Zurakowski D, Millis MB et al (2016) Return to play after periacetabular osteotomy for treatment of acetabular dysplasia in adolescent and young adult athletes. Am J Sports Med 44(6):1573–1581

    Article  PubMed  Google Scholar 

  62. Hara D, Hamai S, Komiyama K, Motomura G, Shiomoto K, Nakashima Y (2017) Sports participation in patients after total hip arthroplasty vs periacetabular osteotomy: a propensity score-matched asian cohort study. J Arthroplasty. https://doi.org/10.1016/j.arth.2017.08.035

    Article  PubMed  Google Scholar 

  63. Novais EN, Heyworth B, Murray K, Johnson VM, Kim Y‑J, Millis MB (2013) Physical activity level improves after periacetabular osteotomy for the treatment of symptomatic hip dysplasia. Clin Orthop Relat Res 471(3):981–988. https://doi.org/10.1007/s11999-012-2578-y

    Article  PubMed  Google Scholar 

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  1. UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    Jens Goronzy & Klaus-Peter Günther

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Goronzy, J., Günther, KP. Hüftdysplasie im Grenzbereich: Welchen Einfluss haben Alter, Arthrose und Begleiterkrankungen auf das Behandlungsergebnis?. Orthopädie 52, 282–292 (2023). https://doi.org/10.1007/s00132-023-04354-w

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