Surgical Treatment of Adolescent Acetabular Dysplasia With a Periacetabular Osteotomy: Does Obesity Increase the Risk of Complications?
BACKGROUND
The Bernese periacetabular osteotomy (PAO) is frequently used to treat symptomatic acetabular dysplasia in the adolescent age group. Despite encouraging results, factors predictive of the development of postoperative complications remain poorly understood. The purpose of this study was to investigate whether obesity is a risk factor for complications following PAO in adolescents.


METHODS
A retrospective cohort study design was used to collect data from 3 different institutions. Children and adolescents (below 19 y of age) who underwent PAO and were followed for minimum of 12 months were included. Obesity was defined as a body mass index ≥95 percentile. The modified Clavien-Dindo classification was used to grade complications. A logistic regression analysis was used to identify factors related to the development of a complication that required treatment outside of routine postoperative care (complication grades II to V). Changes in radiographic parameters including Tönnis acetabular roof angle, anterior center-edge angle, and lateral center-edge angle among obese versus nonobese subjects were also evaluated.


RESULTS
The mean age at surgery among the 84 adolescents included in the study was 16.5 years (range, 12 to 19 y). A total of 11% of the population was considered obese. Obesity (P=0.0047) was the only variable significantly associated with the development of a complication. After controlling for study site, the odds of an obese subject developing a complication were 10 [95% confidence interval (CI), 1.89-59.8] times the odds of a nonobese subject developing a complication. There was no difference in the magnitude of change in anterior center-edge angle (P=0.1251), lateral center-edge angle (P=0.9774), or Tönnis (P=0.5770) angular correction that was achieved among the obese versus nonobese subjects following surgery.


CONCLUSIONS
The Bernese PAO allows for adequate radiographic correction of acetabular dysplasia among obese and nonobese adolescents. However, the hip preservation surgeon should be aware of the higher risk of complications among obese adolescents undergoing PAO for the treatment of symptomatic acetabular dysplasia.


METHODS
Level III-retrospective study.
*Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO ‡Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA §Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO †Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
Eduardo N
EN
Novais
Gorden D
GD
Potter
Rafael J
RJ
Sierra
Young-Jo
YJ
Kim
John C
JC
Clohisy
Perry L
PL
Schoenecker
Robert T
RT
Trousdale
Patrick M
PM
Carry
Michael B
MB
Millis
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006617:Hip Dislocation / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000145:classification / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States