Return to sport and patient satisfaction after periacetabular osteotomy

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Abstract

INTRODUCTION: Developmental dysplasia of the hip (DDH) often affects young, active patients and can lead to early osteoarthritis. Periacetabular osteotomy (PAO) is a joint-preserving surgery to reorient the acetabulum and delay arthritis. The impact of PAO on return to sports and the factors influencing return to sport or patient satisfaction remain insufficiently documented. Therefore we performed a retrospective investigation aiming to: 1) evaluate the rate of return to sport after PAO, 2) identify factors associated with return to sport, patient satisfaction, and the achievement of a patient-acceptable symptom state (PASS). HYPOTHESIS: PAO allows return to sport at a rate exceeding 80% MATERIAL AND METHODS: We reviewed a consecutive series of 43 hips in 42 patients who underwent PAO between 2012 and 2020 at a single center. Data were collected prospectively and analyzed retrospectively. The mean age at surgery was 29.7 ± 9.7 years (range, 13-52), with 35 (83%) women. All patients met inclusion criteria of symptomatic hip dysplasia painful groin symptomatology with a LCEA < 25 ° and Tönnis grade ≤1 osteoarthritis. Clinical outcomes were assessed preoperatively and at last follow-up using patient-reported outcome measures (UCLA, mHHS, HOOS). Patients were surveyed about their return to sports (three‑level, referenced to the pre‑symptom level) and rated their satisfaction (5‑level Likert‑type item). Acceptable symptomatic status (PASS) was defined as reaching threshold scores. Complications were graded with a hip‑adapted Clavien-Dindo scheme. Radiological analysis included LCEA and Tönnis angles pre- and postoperatively, as well as the evolution of osteoarthritis according to the Tönnis classification. Native hip survivorship was estimated using the Kaplan-Meier method, with conversion to, or formal listing for, total hip arthroplasty (THA) defined as the endpoint. RESULTS: At last follow-up (mean follow-up 3.8 years, range 2-12), PROMs improved substantially. UCLA, mHHS and HOOS scores increased from 6.7 ± 1.1 to 8.5 ± 1.3, from 55.9 ± 18.4 to 80.9 ± 14.6 and 49.5 ± 18.5 to 80.9 ± 14.6 respectively (p < 0.001). In total 39/43 patients (91%) returned to sports (22/43 (52%) at a level higher than pre‑op but below pre‑symptom, 17/43 (40%) at the pre‑symptom level); 4/43 (9%) did not return. Return to sport was strongly associated with achieving acceptable symptom status (PASS), with 35/39 (89.7%) of patients returning to sports reaching the PASS threshold compared to 1/4 (25%) among those who did not (p = 0.01). Radiographic parameters did not emerge as significant independent predictors of clinical success in this cohort. No signal of accelerated radiographic deterioration was observed : preoperatively, 42 of 43 hips (98%) were Tönnis grade 0 or 1. Among the 24 hips with available radiographs at final follow-up, 20 out 24 (83%) maintained their preoperative Tönnis grade, with only 4 (17%) showing osteoarthritic progression. The Kaplan-Meier survival probability of the native hip at the mean follow-up of 3.8 years was 97.7% (95% CI: 93.2% - 100%). DISCUSSION: PAO yielded a high short‑term return‑to‑sports rate with large, clinically meaningful PROM gains that align with satisfaction and PASS, with an overall return-to-sport rate above 90%. Limitations include retrospective design, non‑standardized records of sport discipline/exposure, use of non‑PAO‑validated PASS thresholds (used here as a comparability endpoint), and limited long‑term radiographic follow‑up. LEVEL OF EVIDENCE: IV; case series.

Abstract as published, via PubMed.