Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia.
BACKGROUND
Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. Pelvic osteotomies such as the Bernese periacetabular osteotomy can improve the mechanics of the joint, but the results are variable and appear to depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and it potentially could be used to select hips with too severe arthritis to benefit from a joint-preserving reconstructive procedure. The purpose of our study was to identify radiographic, clinical, and magnetic resonance imaging measurements that predict failure after pelvic osteotomy.


METHODS
We performed a cohort study of forty-seven patients undergoing a Bernese periacetabular osteotomy for the treatment of hip dysplasia. Our goal was to identify preoperative radiographic factors, such as the grade of arthritis, joint congruency, and the dGEMRIC index, that are associated with a poor outcome after osteotomy.


RESULTS
Hips in which the osteotomy did not fail had a significant decrease in pain compared with their status preoperatively (p < 0.0001). Hips in which the osteotomy did fail had had significantly more arthritis on preoperative radiographs (as demonstrated by the joint space width and the Tönnis grade [p = 0.01]), more subluxation (p = 0.02), and a lower dGEMRIC index (p < 0.001) than the hips in which the osteotomy did not fail. Multivariate analysis identified the dGEMRIC index as the most important predictor of failure of the osteotomy.


CONCLUSIONS
Bernese periacetabular osteotomy for the treatment of hip dysplasia can decrease pain and improve function in symptomatic dysplastic hips. The dGEMRIC index, as an early measure of osteoarthritis, appears to be useful for identifying poor candidates for a pelvic osteotomy.


METHODS
Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
Cunningham
Torin
T
Children's Hospital, Havard Medical School, Boston, Massachusets, USA.
Jessel
Rebecca
R
Zurakowski
David
D
Millis
Michael B
MB
Kim
Young-Jo
YJ
D000077:Acetabulum / Q000473:pathology / Q000601:surgery*; D000328:Adult; D001848:Bone Diseases, Developmental / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002358:Cartilage, Articular / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010027:Osteotomy; D011237:Predictive Value of Tests; D011859:Radiography; D017211:Treatment Failure
D003287:Contrast Media; D019786:Gadolinium DTPA