title: Acetabular Dysplasia in Middle-Aged Patients: Periacetabular Osteotomy or Total Hip Arthroplasty?
abstract: Treatment of middle-aged patients with acetabular dysplasia is challenging because of mild osteoarthritis, long life span, high activity level, and sports participation. Both periacetabular osteotomy (PAO) and total hip arthroplasty (THA) provide pain relief, improve function, and can last over 2 decades. We compare the 2 procedures for functional outcome (including sports participation), pain relief, and morbidity.
  
  
  
  We compared patients in the 30-50 years age group with symptomatic acetabular dysplasia who underwent PAO (n = 14) or THA (n = 14) with minimum 4-year follow-up. We compared postoperative activity (modified Harris Hip Score, high activity arthroplasty score, and modified Merle d'Aubigné-Postel Score) and sports participation (Tegner and University of California Los Angeles activity scores) in the 2 groups. Morbidity was compared by durations of postoperative pain >4/10, narcotic use, use of gait aids, and time to return to normal activities.
  
  
  
  Sports participation and function scores improved after surgery in both groups without significant intergroup difference at minimum 4-year follow-up. Patients with PAO had longer duration of postoperative pain (P = .01) and used gait aids longer (P = .04) than patients with THA. There were 3 minor reoperations in the PAO group and none in the THA group.
  
  
  
  PAO and THA both produce comparable improvement in sports participation and function. PAO was associated with longer durations of pain and use of gait aids. These findings may be important in the decision-making process in middle-aged patients with symptomatic acetabular dysplasia.
authors.affiliation: Department of Orthopaedics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Niraj V
authors.initials: NV
authors.lastname: Kalore
authors.affiliation: Department of Orthopaedics, PMH Medical Center, Prosser, Washington.
authors.forename: Suresh P R
authors.initials: SP
authors.lastname: Cheppalli
authors.affiliation: Department of Orthopaedics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: William E
authors.initials: WE
authors.lastname: Daner
authors.affiliation: Department of Orthopaedics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: William A
authors.initials: WA
authors.lastname: Jiranek
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005684:Gait; D006617:Hip Dislocation / Q000601:surgery*; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013177:Sports / Q000706:statistics & numerical data*; D013997:Time Factors; D014768:Virginia / Q000453:epidemiology
keywords: acetabular dysplasia; periacetabular osteotomy; rehabilitation; sports participation; total hip arthroplasty