BACKGROUND:Current literature describing the periacetabular osteotomy (PAO) is mostly limited to retrospective case series. Larger, prospective cohort studies are needed to provide better clinical evidence regarding this procedure. The goals of the current study were to (1) report minimum 2-year patient-reported outcomes (pain, hip function, activity, overall health, and quality of life), (2) investigate preoperative clinical and disease characteristics as predictors of clinical outcomes, and (3) report the rate of early failures and reoperations in patients undergoing contemporary PAO surgery. METHODS:A large, prospective, multicenter cohort of PAO procedures was established, and outcomes at a minimum of 2 years were analyzed. A total of 391 hips were included for analysis (79% of the patients were female, and the average patient age was 25.4 years). Patient-reported outcomes, conversion to total hip replacement, reoperations, and major complications were documented. Variables with a p value of ≤0.10 in the univariate linear regressions were included in the multivariate linear regression. The backward stepwise selection method was used to determine the final risk factors of clinical outcomes. RESULTS:Clinical outcome analysis demonstrated major clinically important improvements in pain, function, quality of life, overall health, and activity level. Increasing age and a body mass index status of overweight or obese were predictive of improved results for certain outcome metrics. Male sex and mild acetabular dysplasia were predictive of lesser improvements in certain outcome measures. Three (0.8%) of the hips underwent early conversion to total hip arthroplasty, 12 (3%) required reoperation, and 26 (7%) experienced a major complication. CONCLUSIONS:This large, prospective cohort study demonstrated the clinical success of contemporary PAO surgery for the treatment of symptomatic acetabular dysplasia. Patient and disease characteristics demonstrated predictive value that should be considered in surgical decision-making. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

译文

背景:目前描述髋臼周围截骨术(PAO)的文献大多局限于回顾性病例系列。需要进行更大范围的前瞻性队列研究,以提供有关该程序的更好的临床证据。当前研究的目标是(1)报告至少2年患者报告的结局(疼痛,髋关节功能,活动,总体健康状况和生活质量),(2)研究术前临床和疾病特征作为临床预测指标结果;(3)报告了接受当代PAO手术的患者早期失败和再次手术的比率。
方法:建立了一个大型,前瞻性,多中心的PAO程序队列,并分析了至少2年的结局。总共分析了391个髋关节(79%的患者为女性,平均患者年龄为25.4岁)。记录了患者报告的结局,全髋关节置换术,再次手术和主要并发症。单变量线性回归中p值≤0.10的变量包括在多元线性回归中。使用向后逐步选择方法确定临床结果的最终危险因素。
结果:临床结果分析表明,疼痛,功能,生活质量,整体健康状况和活动水平在临床上具有重要的临床意义。年龄增长和超重或肥胖的体重指数状态预示了某些结局指标的改善结果。男性和轻度髋臼发育不良可预示某些结局指标的改善较小。其中三名(0.8%)的髋关节接受了早期全髋关节置换术的转化,其中12例(3%)的患者需要再次手术,而26例(7%)的患者发生了严重并发症。
结论:这项大型的前瞻性队列研究证明了当代PAO手术治疗有症状的髋臼发育不良的临床成功。患者和疾病特征显示出预测价值,应在手术决策中予以考虑。
证据级别:治疗级别IV。有关证据级别的完整说明,请参见《作者说明》。

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