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  • Title: Periacetabular Osteotomy Redirects the Acetabulum and Improves Pain in Charcot-Marie-Tooth Hip Dysplasia With Higher Complications Compared With Developmental Dysplasia of the Hip.
    Author: Novais EN, Kim YJ, Carry PM, Millis MB.
    Journal: J Pediatr Orthop; 2016 Dec; 36(8):853-859. PubMed ID: 26090966.
    Abstract:
    BACKGROUND: The Bernese periacetabular osteotomy (PAO) is a well-accepted reorientation pelvic osteotomy used to treat symptomatic acetabular dysplasia secondary to developmental dysplasia of the hip (DDH). However, there are limited data regarding PAO in patients with symptomatic hip dysplasia secondary to Charcot-Marie-Tooth disease. METHODS: We compared patients who underwent PAO for the treatment of Charcot-Marie-Tooth disease hip dysplasia (CMTHD group) with patients who underwent PAO for treatment of hip dysplasia secondary to DDH in terms of (1) modified Harris Hip scores; (2) radiographic correction of acetabular dysplasia; and (3) the rate of complications. Twenty-seven subjects with Charcot-Marie-Tooth disease who underwent a PAO between January 1991 and December 2010 were matched to 54 subjects with DDH on the basis of sex, age, date of surgery, and body mass index. Preoperative and postoperative hip functional scores and radiographic data were collected with a minimum 2-year follow-up. The modified Harris Hip Scores (mHHS) assessed functional hip outcomes. Radiographic variables included lateral (LCEA) and anterior (ACEA) center-edge angles, Tönnis angle and Tönnis grade of arthritis. Postoperative complications were classified according to a modified Dindo-Clavien system. RESULTS: At latest follow-up mHHS improved in the CMTHD group (preoperative median 63; (interquartile range [IQR]=54-70 to postoperative median 88; IQR=74-91); P=0.004) and in the DDH groups (preoperative median 71; IQR=58-83 to postoperative median 86; IQR=73-96; P=0.002) with no difference between the 2 groups (P=0.631). Radiographic improvement (LCEA: mean difference, 36 degrees, 95% confidence interval [CI], 30-41 degrees, P<0.001; ACEA: mean difference, 27 degrees, 95% CI, 20-33 degrees, P<0.001; Tönnis angles: mean difference, 21 degrees, 95% CI, 15-26 degrees, P<0.001) was achieved in the CMTHD group. Similarly, radiographic improvements in LCEA (mean difference, 33 degrees, 95% CI, 29-37 degrees, P<0.001), ACEA (mean difference, 18 degrees, 95% CI, 13-23 degrees, P<0.001) and Tönnis angles (mean difference, 13 degrees, 95% CI, 9-17 degrees, P<0.001) were also achieved in the DDH group. After PAO, 33% of the patients in the CMTHD group and 13% in the DDH group developed a complication that required treatment (odds ratio, 3.4; 95% CI, 1.1-10.4; P=0.035). CONCLUSIONS: The Bernese PAO is capable of comprehensively achieving improvement in patient-reported outcome scores and redirecting the acetabulum in symptomatic acetabular dysplasia secondary to CMTHD. However, patients with CMTHD have a higher risk for developing complications. LEVEL OF EVIDENCE: Level III-therapeutic study.
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