Patient-reported outcomes of transposition osteotomy of the acetabulum and contralateral total hip arthroplasty in patients with bilateral hip dysplasia.

PURPOSE: To clarify differences in hip-specific function, satisfaction, and patient preference between transposition osteotomy of the acetabulum (TOA) and contralateral total hip arthroplasty (THA) in the same patients with bilateral hip dysplasia.

METHODS

Among 689 patients who underwent TOA between 1998 and 2019, 32 patients who also underwent contralateral THA were included. Median age at surgery was 46 years for TOA and 50 years for THA (p = 0.008), and median follow-up was 14 and 12 years, respectively (p = 0.049). Postoperative patient-reported outcome measures included pain and satisfaction visual analogue scales (VAS), the Forgotten Joint Score-12 (FJS-12), and the Hip disability and Osteoarthritis Outcome Score (HOOS). Patients were also asked which hip they preferred.

RESULTS

Preoperative modified Harris Hip Score (mHHS) was higher in TOA hips than in THA hips (64 vs. 43; p < 0.001), whereas the latest mHHS was lower in TOA hips (92 vs. 96; p = 0.007). Although pain VAS, FJS-12, and all HOOS subscales were comparable between TOA and THA, satisfaction VAS was higher in THA hips (98 vs. 93; p = 0.029). Fifteen patients (47%) preferred THA, nine (28%) reported no difference, and eight (25%) preferred TOA. The most common reason for preferring THA was less pain (10 of 15 patients, 67%).

CONCLUSIONS

In middle-aged patients with bilateral hip dysplasia, TOA and contralateral THA yielded comparable functional outcomes; however, satisfaction was higher after THA, and 47% preferred THA. These findings may inform shared decision-making regarding joint-preserving surgery and arthroplasty.