Importance of Labral Injury in Periacetabular Osteotomy: Implications for Joint Preservation in Developmental Dysplasia of the Hip.

Abstract

It remains unclear as to whether the clinical outcomes of periacetabular osteotomy (PAO) are influenced by the location and severity of preoperative labral injuries. This study aimed to examine the relationship between labral tear severity and clinical outcomes in patients undergoing PAO, with a focus on patient-reported outcomes and magnetic resonance imaging (MRI) assessments. This retrospective study included 40 patients (46 hips) who had undergone PAO for developmental dysplasia of the hip between 2015 and 2022. Patients were selected based on the availability of preoperative and postoperative clinical scores and MRI data. Clinical outcomes were measured using the Harris Hip Score, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, and the Hip disability and Osteoarthritis Outcome Score (HOOS). Magnetic resonance imaging was used to assess labral damage, which was graded from normal to severe. Postoperative improvements in radiographic parameters and clinical scores were observed. Labral injuries were common, particularly in the anterior region. The presence of complicated labral injuries in the anterior region was associated with greater improvement in the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and Hip disability and Osteoarthritis Outcome scores. In contrast, complicated labral injuries in the superior region were associated with less improvement. This study highlights the important effect of complicated labral injuries in the superior region on short-term clinical outcomes following PAO in patients who have dysplasia of the hip. Although PAO effectively improves acetabular coverage and alleviates symptoms, severe superior labral damage may necessitate additional intra-articular procedures such as labral suturing to optimize patient outcomes.