Total hip arthroplasty after periacetabular osteotomy.

Abstract

Patients with hip dysplasia often endure multiple surgical interventions, first in attempts to preserve their biologic hips and later for total hip arthroplasty (THA). Each different surgical approach traumatizes the musculoligamentous complex of the hip. These cumulative insults can significantly affect THA success. We retrospectively reviewed 8 patients who underwent THA after previous periacetabular osteotomy via the same anterior approach. Acetabular bone stock required no augmentation for implant coverage. No complication occurred during surgery. All patients increased their functional score at last follow-up. No dislocation or implant loosening occurred. Leg-length restoration was excellent. Periacetabular osteotomy is a proven conservative procedure in dysplastic hips that can be realized through a Smith-Petersen incision. Restoration of the acetabular anatomy is achieved with limited muscle detachment. Good results have been achieved with periacetabular osteotomy; however, some patients develop increasing pain from progression of osteoarthritis and require a THA to allow relief of symptoms. The anterior-approach THA is a well-established procedure using the same Smith-Petersen interval as periacetabular osteotomy. Using this approach for both procedures optimizes the patient's immediate and ultimate functional recovery and hip stability. Instead of compromising subsequent THA, periacetabular osteotomy may improve THA results in dysplastic hips.