AJSM - 2026-09-21 - Journal Article
Periacetabular Osteotomy and Combined Open Femoral Head-Neck Junction Osteochondroplasty: A Concise Follow-up of a Previous Report at a Mean 10-Year Follow-up.
Shah VP, O'Connor KP, Harris M, Nepple JJ, Pascual-Garrido C, Clohisy JC
Topics
Key Takeaway
PAO with concurrent femoral head-neck osteochondroplasty reduced 10-year reoperation rate from 33% to 8% (P=.005) compared to PAO alone, driven by elimination of secondary FAI procedures.
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Summary
This retrospective matched cohort study compared outcomes of PAO with versus without concurrent femoral head-neck osteochondroplasty in symptomatic acetabular dysplasia at mean 10-year follow-up. Both groups achieved similar mHHS improvements, MCID attainment, and PASS rates (all P>.05). The PAO-only group had a significantly higher reoperation rate (33% vs. 8%, P=.005) and a numerically higher THA conversion rate (14% vs. 3%, P=.07), with Kaplan-Meier 10-year reoperation-free survival of 72.9% versus 97.4%.
Key Limitation
The absence of standardized, prospectively defined indications for OCP in the PAO+OCP group means the two cohorts may differ in baseline cam severity, making it impossible to determine whether the reoperation benefit reflects the OCP itself or patient selection.
Original Abstract
BACKGROUND
Hip dysplasia is a well-established cause of hip dysfunction and secondary osteoarthritis in young adults. Periacetabular osteotomy (PAO) is a common surgical treatment for symptomatic acetabular dysplasia. Recent awareness of concomitant impingement in dysplastic hips has led to inclusion of osteochondroplasty (OCP) for femoral head-neck abnormalities in select cases to improve survivorship and clinical outcomes.
PURPOSE
To compare outcomes, reoperation rates, radiography, survivorship, and complications at a mean of 10 years after PAO with and without femoral head-neck OCP.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
The authors conducted a retrospective review of the data of 38 patients (38 hips) who underwent PAO with OCP compared to a matched control group of 42 patients (42 hips) who underwent PAO only between 2000 and 2007. Outcomes included the modified Harris Hip Score (mHHS) and Western Ontario and McMaster Universities Osteoarthritis Index score. Failure was defined as clinical failure (failure to meet mHHS minimal clinically important difference [MCID] or Patient Acceptable Symptom State [PASS]), conversion to total hip arthroplasty (THA), reoperation, and composite failure (either clinical failure or reoperation).
RESULTS
The mean follow-up was 10.6 years (range, 6.9-16.3 years) for the PAO+OCP cohort and 11.8 years (range, 7.2-17.2 years) for the PAO-only cohort. Both groups showed similar improvements in outcomes, MCID, PASS, and rates of clinical failure ( P > .05). The PAO-only group had a higher reoperation rate (33%) compared to the PAO+OCP group (8%) ( P = .005), with 4 reoperations in the PAO-only group due to secondary femoroacetabular impingement and included OCP and labral repair. THA conversion rates were 14% in the PAO-only group and 3% in the PAO+OCP group ( P = .07). The Kaplan-Meier (KM) 10-year survivorship estimations from clinical failure were 93.8% and 89.2% for the PAO+OCP and PAO-only groups, respectively. The KM 10-year survivorship estimations from reoperation were 97.4% and 72.9%, respectively. The KM 10-year survivorship estimations from composite failure were 93.8% and 89.7%, respectively.
CONCLUSION
At a mean follow-up of 10 years, PAO+OCP and PAO-only procedures demonstrated similar outcome improvements. However, the PAO-only group had a higher reoperation rate, primarily due to residual impingement. These findings suggest that concurrent OCP may reduce the need for secondary procedures without compromising clinical outcomes. Further long-term studies are needed to investigate the effect of residual impingement on joint health after PAO.