Background: 

The optimal surgical treatment (hip arthroscopy compared with periacetabular osteotomy [PAO]) for borderline acetabular dysplasia (lateral center-edge angle [LCEA], 18° to 25°) remains a topic of debate. To date, the literature has focused primarily on arthroscopy outcomes, with only a few small reports on PAO outcomes. The purpose of this study was to define PAO outcomes in a large cohort of borderline hips. In a secondary analysis, we assessed the effect of prior failed arthroscopy, concurrent hip arthroscopy, and concurrent femoral osteoplasty on PAO outcomes in this cohort.

Methods: 

A prospective database was retrospectively reviewed for patients who underwent PAO for symptomatic instability in the setting of borderline dysplasia (LCEA, 18° to 25°). Of the 232 identified hips, 186 (80.2%) were assessed at a mean follow-up of 3.3 ± 2.0 years postoperatively. The mean patient age was 25.2 ± 8.5 years (range, 14 to 45 years), and 88.2% were female. Thirty hips (16.1%) had undergone a failed prior arthroscopy. Arthroscopy was performed concurrently with the PAO in 130 hips (69.9%), and femoral osteoplasty was performed concurrently in 120 hips (64.5%). The modified Harris hip score (mHHS) was assessed relative to the minimal clinically important difference (MCID) of 8 and patient acceptable symptom state (PASS) of 74. Clinical failure was defined as a reoperation for persistent symptoms or a failure to achieve either the mHHS MCID or PASS.

Results: 

Of the 156 hips undergoing a primary surgical procedure, clinical success was achieved in 148 hips (94.9% [95% confidence interval (CI), 90.2% to 97.4%]). Two hips (1.3% [95% CI, 0.4% to 4.6%]) underwent reoperation (hip arthroscopy) for persistent symptoms and an additional 6 hips (3.8% [95% CI, 1.8% to 8.1%]) failed to achieve the mHHS MCID or PASS, for a clinical failure rate of 5.1% (95% CI, 2.6% to 9.8%); 8.8% reported dissatisfaction with the surgical procedure. Clinical failure was more frequent among the 30 hips (23.3% [95% CI, 11.8% to 40.9%]; p = 0.001) that had undergone a prior failed arthroscopy. There were no outcome differences between hips that had or had not undergone concurrent hip arthroscopy or femoral osteoplasty.

Conclusions: 

This study demonstrates excellent early outcomes of PAO for borderline acetabular dysplasia, with significant clinical improvement in 94.9% of patients undergoing a primary surgical procedure; 91.2% were satisfied with the surgical procedure.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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交界性髋臼发育不良的髋臼周围截骨术的结果

背景： 

交界性髋臼发育不良（横向中心边缘角 [LCEA]，18° 至 25°）的最佳手术治疗（髋关节镜检查与髋臼周围截骨术 [PAO] 相比）仍然是一个争论的话题。迄今为止，文献主要关注关节镜检查结果，只有少数关于 PAO 结果的小报告。本研究的目的是在一大群临界髋关节中定义 PAO 结果。在二次分析中，我们评估了先前失败的关节镜检查、同期髋关节镜检查和同期股骨骨成形术对该队列中 PAO 结果的影响。

方法： 

对一个前瞻性数据库进行了回顾性分析，以了解在边缘性发育不良 (LCEA，18° 至 25°) 的情况下因症状不稳定而接受 PAO 的患者。在 232 个确定的髋关节中，186 个 (80.2%) 在术后平均随访 3.3 ± 2.0 年时进行了评估。平均患者年龄为 25.2 ± 8.5 岁（范围为 14 至 45 岁），88.2% 为女性。30 个髋关节 (16.1%) 之前接受过失败的关节镜检查。在 130 髋 (69.9%) 中同时进行了关节镜检查和 PAO，在 120 髋 (64.5%) 中同时进行了股骨骨成形术。相对于 8 的最小临床重要差异 (MCID) 和 74 的患者可接受症状状态 (PASS) 评估改良的 Harris 髋关节评分 (mHHS)。

结果： 

在接受初次手术的 156 髋中，有 148 髋取得了临床成功（94.9% [95% 置信区间 (CI)，90.2% 至 97.4%]）。两个髋关节 (1.3% [95% CI, 0.4% 至 4.6%]) 因持续症状接受再次手术（髋关节镜检查），另外 6 个髋关节 (3.8% [95% CI, 1.8% 至 8.1%]) 未能达到mHHS MCID 或通过，临床失败率为 5.1%（95% CI，2.6% 至 9.8%）；8.8% 的人表示对手术过程不满意。30 个髋关节镜检查失败的髋关节（23.3% [95% CI，11.8% 至 40.9%]；p = 0.001）的临床失败率更高。有或没有同时进行髋关节镜检查或股骨成形术的髋关节之间没有结果差异。

结论： 

这项研究表明 PAO 治疗交界性髋臼发育不良的早期结果非常好，94.9% 的患者在接受初次外科手术时有显着的临床改善；91.2% 对手术过程满意。

证据等级： 

治疗等级IV。有关证据等级的完整描述，请参阅作者须知。