Short term-outcomes of periacetabular osteotomy in the neuromuscular hip.

Abstract

The study aims to evaluate our experience of the Bernese periacetabular osteotomy (PAO) in patients with neurogenic hip dysplasia. Retrospective data were collected for patients with neurogenic hip dysplasia, managed with PAO over a 10-year period. Data were collected for 20 consecutive patients (23 hips). Mean age at the time of surgery was 15 years (range 12-31). 85% had a diagnosis of cerebral palsy (GMFCS 1(18%), 2(18%), 3(35%), 4(12%), 5(18%)). Mean follow up was 47 months. Electronic records were reviewed for outcomes. Pre- and post-operative radiographs were evaluated separately by two independent assessors using TraumaCad software. Post-operative radiographic evaluation was available for 20 patients (21 hips). The median lateral centre edge angle was corrected from -1° pre-operatively (range: -58° to 25°) to 42° post operatively (range: 15° to 65°). Tönnis angle was corrected from an average of 26° pre-operatively (range: 10° to 37°) to 9° post-operatively (range: -19 to 29). Reimer's index decreased from an average of 50% (range: 27% to 93%) to 7% (range 0% to 25%) post-operatively. At the latest follow there was absence of pain in 16 patients. Our experience has demonstrated safe use of the PAO, in conjunction with soft tissue procedures and femoral osteotomy, in the management of neuromuscular patients. In this cohort there was stable reduction of the hip in all but two patients (three hips), and effective pain management for this challenging patient group.