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Wyatt P, Cole S, Satalich J, Ernst BS, Cyrus J, Vap A, O'Connell R. Periacetabular osteotomy with and without concomitant arthroscopy: a systematic review of evidence on post-operative activity levels and return to sport. J Hip Preserv Surg 2024; 11:98-112. [PMID: 39070206 PMCID: PMC11272631 DOI: 10.1093/jhps/hnad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/06/2023] [Accepted: 10/24/2023] [Indexed: 07/30/2024] Open
Abstract
The purpose of this systematic review is to (i) compare post-operative activity levels after periacetabular osteotomy (PAO) versus PAO + HA (concomitant PAO and hip arthroscopy) using patient-reported outcomes that specifically assess activity and sports participation [Hip Disability and Osteoarthritis Outcome Score-Sport and Recreation subscale (HOOS-SR), University of California Los Angeles (UCLA) activity score, Hip Outcome Score-Sport-Specific Subscale (HOS-SSS)] and (ii) compare post-operative return to sport (RTS) data between PAO and PAO + HA groups. A systematic review of literature was conducted on 1 June 2023, utilizing PubMed, Cochrane and Embase (OVID). Articles were screened for inclusion using specific inclusion and exclusion criteria. Twenty-six out of 1610 articles met all inclusion criteria, without meeting any exclusion criteria. In the 12 studies containing only subjects who underwent PAO alone, 11 demonstrated an average score improvement in UCLA, HOOS-SR or HOS-SSS post-operatively (P < 0.05). In the three studies containing subjects who underwent PAO with concomitant HA, significant improvements were seen in the HOS-SS and UCLA scores (P < 0.05). In the five studies that directly compared UCLA, HOS-SSS and HOOS-SSS scores between PAO groups and PAO + HA groups, all demonstrated statistically significant improvement post-operatively (P < 0.05). The rate of RTS ranged from 63% to 90.8% among PAO studies and was found to be 81% in the single PAO + HA study that assessed RTS. When performed in patients with intra-articular pathology, concomitant PAO + HA may provide similar sport-related outcomes to PAO alone in patients without intra-articular pathology.
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Affiliation(s)
- Phillip Wyatt
- Virginia Commonwealth University School of Medicine, 1000 E Marshall St, Richmond, VA 23298, USA
| | - Sarah Cole
- Virginia Commonwealth University School of Medicine, 1000 E Marshall St, Richmond, VA 23298, USA
| | - James Satalich
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, 1200 E Broad St, 9th Floor, Box 980153, Richmond, VA 23298, USA
| | - Brady S Ernst
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, 1200 E Broad St, 9th Floor, Box 980153, Richmond, VA 23298, USA
| | - John Cyrus
- Virginia Commonwealth University School of Medicine, 1000 E Marshall St, Richmond, VA 23298, USA
| | - Alexander Vap
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, 1200 E Broad St, 9th Floor, Box 980153, Richmond, VA 23298, USA
| | - Robert O'Connell
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, 1200 E Broad St, 9th Floor, Box 980153, Richmond, VA 23298, USA
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Nelson CT, Reiter CR, Harris M, Edge C, Satalich J, O'Neill C, Cyrus J, Vap A. Femoral rotational osteotomy for femoroacetabular impingement: A systematic review. J Orthop 2024; 50:139-148. [PMID: 38283872 PMCID: PMC10818154 DOI: 10.1016/j.jor.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To synthesize existing literature regarding the indications and outcomes of femoral rotational osteotomies (FDO) for femoroacetabular impingement (FAI) due to. Methods Medline, Cochrane, and Embase were searched using keywords "femoroacetabular impingement", "rotational osteotomy" and others to identify FAI patients undergoing FDO. Double-screened studies were reviewed by blinded authors according to inclusion criteria. Data from full texts was extracted including study type, number of patients, sex, mean age, surgical indication, type of dysplasia, associated pathology, surgical technique, follow-up, and pre-op/post-op evaluations of the following: impingement test, femoral version (FV), 'other angles measured', outcome scores, range of motion (ROM). Results 7 studies including 91 patients (97 FDO surgeries), 73 females (80 %) with mean age of 28.3 years, and follow-up mean of 2.44 ± 2.83 years. Pain or impingement was the most common clinical indication, while others included aberrant FV and ROM measurements for both anteverted and retroverted femurs. There were reports of FDO being performed with concomitant procedures addressing other pathology. Various outcome scores and ROM measurements showed postoperative improvement after FDO. Complication data was sparse, preventing aggregation. The rate of unplanned reoperation was 40 % (where reported), with 'hardware removal' being the most common. Conclusions FDO is effective in treating FAI due to increased FV, improving clinical symptoms, and potentially delaying articular degeneration. Hardware removal surgery remains an inherent risk in undergoing FDO. Further work is needed to discover indications warranting FDO as a primary treatment versus hip arthroscopy. Level of evidence This review contains 4 studies with Level IV evidence and 3 studies with Level III evidence.
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Affiliation(s)
- Chase T. Nelson
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Charles R. Reiter
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Matthew Harris
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Carl Edge
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Box 980153, Richmond, VA, 23298-0153, USA
| | - James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Box 980153, Richmond, VA, 23298-0153, USA
| | - Conor O'Neill
- Department of Orthopaedic Surgery, Duke Health, 200 Trent Dr Ste 1F, Durham, NC, 27710, USA
| | - John Cyrus
- Health Sciences Library, MCV Campus at Virginia Commonwealth University, 509 N. 12th St., Box 980582, Richmond, VA, 23298-0582, USA
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Box 980153, Richmond, VA, 23298-0153, USA
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Goronzy J, Günther KP. [Hip dysplasia: What influence do age, arthrosis and concomitant diseases have on the treatment result?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:282-292. [PMID: 36894594 DOI: 10.1007/s00132-023-04354-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/11/2023]
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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Affiliation(s)
- Jens Goronzy
- UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Klaus-Peter Günther
- UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Curley AJ, Padmanabhan S, Chishti Z, Parsa A, Jimenez AE, Domb BG. Periacetabular Osteotomy in Athletes With Symptomatic Hip Dysplasia Allows for Participation in Low-, Moderate-, and High-Impact Sports, With Greater Than 70% Return to Sport for Competitive Athletes: A Systematic Review. Arthroscopy 2023; 39:868-880. [PMID: 36528217 DOI: 10.1016/j.arthro.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To systematically review the literature and report the rate of return to sport (RTS) in athletes following periacetabular osteotomy (PAO) for symptomatic hip dysplasia. METHODS A literature search of the PubMed, Embase, and Cochrane Library databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting on athletes undergoing PAO surgery for symptomatic hip dysplasia. A quality assessment was performed using the Methodological Index of Non-Randomized Studies (MINORS) grading system. Data collection included study characteristics, demographics, radiographic measurements, rate and timing of RTS, baseline and most recent patient-reported outcomes (PROs), and subsequent surgeries. RESULTS Six studies met inclusion criteria with 341 patients undergoing PAO. There were 2 level III and 4 level IV studies, with an average MINORS score of 11. Preoperative and postoperative lateral center edge angles ranged from 8° to 18° and 23° to 41.3°, respectively. One study reported solely on dancers with a 63% rate of RTS at 1 year postoperatively. Two other studies reported RTS of 80% and 82% for multiple sports, with slightly lower rates (73% and 78%) in competitive athletes. Three studies demonstrated a comparable distribution of sports participation, from the preoperative to postoperative period, in low-impact (61.4% to 72.1% and 63.7% to 85.7%), moderate-impact (10.3% to 21.0% and 4.3% to 25.4%), and high-impact (8.5% to 17.6% and 5.1% to 10.8%) sports. Three studies reported time to RTS after PAO, ranging from 8.8 to 12.8 months. Of the 3 studies noting reasons for not returning to sport, concerns related to the operative hip ranged from 36.4% to 67%. Of the studies that reported both preoperative and postoperative PROs, improvements in all values were observed, with modified Harris Hip Scores and Hip Disability Osteoarthritis Outcome Scores at most recent follow-up ranging from 81 to 95 and 72 to 93, respectively. CONCLUSIONS In athletes with symptomatic hip dysplasia undergoing PAO, postoperative participation in low-, moderate-, and high-impact sports was observed, with greater than 70% RTS for competitive athletes. These findings suggest that PAO, with appropriate indications, is an efficacious treatment option in this active patient population with severe dysplasia. LEVEL OF EVIDENCE Level IV, systematic review of level III and IV studies.
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Affiliation(s)
- Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - Zayd Chishti
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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