Background: Acetabular dysplasia associated with deformity of the
proximal part of the femur can result in hip dysfunction and degenerative
arthritis in young adults. The optimal method of surgical correction for these
challenging combined deformities remains controversial.
Methods: We retrospectively analyzed twenty-four hips in twenty
patients who underwent a Bernese periacetabular osteotomy, which was done with
a proximal femoral valgus-producing osteotomy in thirteen hips, for the
treatment of acetabular dysplasia associated with proximal femoral structural
abnormalities. The average age of the patients at the time of surgery was 22.7
years, and the average duration of clinical follow-up was 4.5 years. The
Harris hip score and overall patient satisfaction with surgery were used to
assess hip function and clinical results. Plain radiographs were used to
assess the correction of the deformity, healing of the osteotomy, and
progression of degenerative arthritis.
Results: The mean Harris hip score increased from 68.8 points
preoperatively to 91.3 points at the time of the most recent follow-up (p <
0.0001). Sixteen patients (nineteen hips) had an excellent clinical result,
and one patient (one hip) had a good result. Two patients (two hips) had a
fair result, and one patient (two hips) had a poor result. Twenty-two of the
twenty-four hips improved clinically. There was an average improvement of
27.6° in the lateral center-edge angle of Wiberg (p < 0.0001), an
average improvement of 33.1° in the anterior center-edge angle of Lequesne
and de Seze (p < 0.0001), and an average improvement of 16.5° in the
acetabular roof obliquity (p < 0.0001). The hip center was translated
medially an average of 6.3 mm (p = 0.0003). The Tönnis osteoarthritis
grade was unchanged in twenty hips, progressed one grade in three hips, and
progressed two grades in one hip. There were three major technical
complications. At the time of the most recent follow-up, none of the hips had
required total hip arthroplasty.
Conclusions: The combination of acetabular dysplasia and proximal
femoral deformities presents a complex reconstructive problem. The range of
motion and radiographic assessment of the hip are major factors in the
selection of patients for surgery. In selected patients, the periacetabular
osteotomy combined with concurrent femoral procedures, when indicated, can
provide comprehensive deformity correction and improved hip function.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.