Periacetabular Osteotomy versus Total Hip Arthroplasty for Symptomatic Acetabular Dysplasia in Patients Aged 40 Years or Above.

BACKGROUND

Patient acceptable symptomatic state (PASS) achievement, reoperation rates, and survivorship were compared between periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia and total hip arthroplasty (THA) in patients aged 40 to 49 years.

METHODS

Patients aged 40 to 49 years undergoing PAO or THA were retrospectively reviewed. The PAO patients who had a body mass index (BMI) ≥ 30 or a Tönnis grade ≥ 2 were excluded. The THA patients who had a BMI ≥ 30, a Tönnis grade ≥ 3, or arthritic etiologies following slipped capital femoral epiphysis, Legg-Calve-Perthes, osteonecrosis, and/or trauma were excluded. Postoperative modified Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score-Joint Replacement were collected at a minimum of 1 year following PAO and THA, respectively (mean follow-up 3.7 versus 3.2 years). Established 2-year thresholds defined PASS. Survival analysis compared procedures with an endpoint of subsequent ipsilateral surgery (excluding hardware removal). There were 103 hips (n = 42 PAO, n = 61 THA) analyzed. Sex, average age, BMI, and lateral center edge angle within the PAO group were 95.2% women, 43 years, 23.1, and 16.9 degrees, respectively, compared to 78.7% women, 45 years, 24.2, and 20.0 degrees in the THA group (P = 0.02, <0.01, 0.10, and 0.10, respectively).

RESULTS

There were 72% of PAO compared to 61% of THA patients who achieved PASS (P = 0.28). History of prior ipsilateral surgery was associated with failure to achieve PASS (37 versus 6%, P < 0.001). The rate of subsequent surgery was 5% in each cohort (P = 1.0). The mean time-to-event was 11.2 and 7.8 years in the PAO and THA cohorts, respectively. Survivorship free of reoperation was 91% at five and 8 years among PAOs and 95% at five and 8 years among THAs (P = 0.94).

CONCLUSIONS

Patients aged 40 to 49 years undergoing PAO and THA have similar PASS achievement without differences in reoperation. Both procedures are viable surgical options in quadragenarians, with high survivorship maintained at five and 8 years. Thoughtful patient and physician dialogue incorporating all management options and the patient's goals should drive surgical decision-making.