Original Article
Periacetabular Osteotomy and Total Hip Arthroplasty in Patients Older Than 40 Years

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Abstract

The objective of this study was to investigate quality of life (QOL) in patients with dysplasia who were older than 40 years and who underwent Bernese periacetabular osteotomy (PAO). Quality of life was compared among 28 patients who underwent PAO and 33 patients of the same age who underwent total hip arthroplasty (THA). Outcome tools included the Western Ontario McMasters Universities (WOMAC) Osteoarthritis Index and the 12-Item Short-Form Health Survey. Seventy-three percent of PAO patients achieved a “very good” (75-100) outcome or a “good” (65-75) QOL score in pain dimension and 64% in function dimension at 4 years after operation. WOMAC pain (89 vs 71, P < .005) and function (90 vs 74, P < .005) scores were significantly better among THA patients (THA vs PAO). Although THA resulted in better QOL, osteotomy still provided excellent QOL outcome in a high percentage of patients older than 40 years. However, given the results of this study, in patients older than 40 years, periacetabular osteotomy should only be done in highly selected cases.

Section snippets

Materials and Methods

The study design was a cross-sectional, cohort comparison study in patients with an underlying diagnosis of dysplasia who had undergone either PAO or total hip arthroplasty (THA). Periacetabular osteotomy cases were identified at a single hospital between 1995 and 2003. The study was granted ethical approval by the institutional review board. Inclusion criteria were a primary diagnosis of dysplasia, minimal or no osteoarthritis (Tonnis grade 0 or 1), age older than 40 years, and the potential

Results

The mean age of PAO and THA patients were 45.4 and 47.1 years, respectively (P = .2, t test). Ninety percent (25/28) of PAO patients were women compared with 88% (30/34) of THA patients (P = .9, χ2 test).

Quality-of-life outcomes are summarized in Fig. 1, Fig. 2. There were statistically significant differences in WOMAC pain and functional scores at 4 years favoring treatment with THA, as shown in Fig. 1, Fig. 2. In the pain dimension, the mean WOMAC scores (THA vs PAO) were 89.2 vs 70.9 (P <

Discussion

Periacetabular osteotomy has been shown to be an effective treatment in patients with dysplasia and minimal or no osteoarthritis 2, 10, 11. This joint-conserving operation can significantly improve patient QOL 4, 11. In patients older than 40 years, there is a controversy over the relative merits of joint-preserving surgeries such as PAO and THA. The choice of THA is becoming more attractive through improvements in bearing surfaces such as highly cross-linked polyethylene, and

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No benefits or funds were received in support of the study.

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