Pelvic osteotomies for hip dysplasia results can be variable and 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 could be used to select hips that would benefit from a joint-preserving reconstructive procedure. Our objective was to investigate the role of preoperative dGEMRIC in predicting the success of PAO in patients 40 and above. We hypothesized that patients who failed had lower preoperative dGEMRIC index compared to those who did not.

Following IRB approval, patients 40 or older who underwent PAO between 1990–2013 and had preoperative dGEMRIC scan and minimum follow-up of 4 years were identified. Patients with prior hip surgeries or any pathologies were removed leading to a total of 70 patients (Age: 44.2 ± 2.9 years old, BMI: 25.7 ± 4.5 Kg/m²). We only included the first hip undergoing PAO for those with bilateral PAO. Out of 70, 19 had failure defined by the need for total hip replacement or WOMAC pain score of 10 and above within 10 years after index PAO surgery. Articular cartilage was segmented on the 3D pre-operative dGEMRIC scan. The average thickness and dGEMRIC index across the whole articular surface were analyzed.

Failed hips had a lower dGEMRIC index by 115 ± 20 ms (P<0.001). All but one failed hips had a dGMERIC index of 400 or less (range: 313 – 479 ms), while all survived hips had a dGMERIC index of greater than 400 (range: 403 – 691 ms). Similar trends were observed when comparing the dGEMRIC index within the 6 subgroups (P<0.01). There were no differences in cartilage thickness (combined femoral head and acetabular cartilage) between the failed and survived hips (p>0.2).

Patients with a high dGMERIC index (indicating high GAG content) may have a higher chance of successful outcomes following PAO. Current efforts are underway to develop a multi-modal predictive model to evaluate risk of failure after PAO.

The purpose of this study is to understand the lived experience of mature patients who undergo a periacetabular osteotomy (PAO), a major surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to better understand how the PAO impacted the lives of the patients and their families, with a long-term goal of improving the experience.

We utilized a phenomenological approach with in-depth, semi-structured interviews to investigate the experience of seven women, ages 25–40, who underwent a PAO. A modified intensity sampling method coupled with criterion sampling was used. Inclusion criteria included raising at least one child and being in a committed relationship with a partner.

Analysis of interview transcripts revealed eight themes, each of which falls into one of three chronological periods.

From the start of dysplasia symptoms until meeting the PAO surgeon: (1) frustration with symptoms disrupting daily activities, (2) discouragement from misdiagnoses and lack of explanation for symptoms, and (3) fear of the PAO operation.

During the PAO decision-making process: (1) the importance of education regarding the PAO procedure and full understanding of its purpose, and (2) the utility of social media to learn from past PAO patients in order to feel more confident about the decision to undergo PAO.

Post-operation through recovery: (1) feelings of helplessness, isolation and difficulty asking for help, (2) relying heavily on family and/or close friends for assistance, and (3) desire for more support and communication from the healthcare team.

Our findings suggest that the psychosocial burden of PAO surgery is great, with major impact on the patient and family. Many important issues lie outside the scope of what healthcare teams currently address.

Slipped capital femoral epiphysis (SCFE) is associated with a spectrum of proximal femoral deformity and femoroacetabular impingement (FAI). Little attention has been given, however, to the possible effect of SCFE on remaining hip growth. Our observation that some acetabula in hips with SCFE have various dysmorphology led us to evaluate the growth of the hip in our patients with SCFE. We performed an IRB-approved retrospective study of our intramural SCFE database which identified 108 hips with unilateral SCFE, at least 2 years of radiographic followup, and closure of triradiate cartilage, greater trochanter and proximal femoral physis. The contralateral non-SCFE hip was used as control. Average age at presentation was 12.3 y. 49 patients were male, 59 female.

Statistically significant differences were noted between SCFE and control hip both at both presentation and last followup(FU): Mean LCEA lower in SCFE hip at presentation by 0.97 degree; increasing to 4.36 degrees at last FU(p<0.0001). No difference noted in mean Tonnis roof angle at presentation, but at last FU SCFE hips had mean roof angle difference of 3.2 degrees higher than control(p<.0001).

In some of our SCFE patients, acetabular deformity has impacted treatment. Ongoing studies may clarify risk factors for the development of problematic acetabular deformity associated with SCFE and perhaps allow prevention of secondary acetabular deformity.

Purpose

Periacetabular osteotomy (PAO) is a versatile acetabular reorienting procedure that is most commonly used to provide greater femoral head coverage in adolescent hip dysplasia. However, PAO can also be used to reorient the acetabulum in the opposite direction to treat femoroacetabular impingement (FAI) due to acetabular over-coverage. We describe the indications, surgical technique, and early results of reverse PAO to reduce femoral head coverage in symptomatic hips with FAI due to acetabular over-coverage.

Purpose

Factors contributing to chronic postoperative pain (CPOP) are poorly defined in young people and developmental considerations are poorly understood. With over 5 million children undergoing surgery yearly and 25% of adults referred to chronic pain clinics identifying surgery as the antecedent, there is a need to elucidate factors that contribute to CPOP in young people. The present study includes patients undergoing hip preservation surgery at a children's hospital.

We report our early Boston experience with the technique of Ganz, et al., for surgical dislocation of the hip, which provides a safe, powerful approach to certain major intraarticular hip problems.

Materials and Methods: Forty-seven hips with various mechanical disorders have been treated using the Ganz technique of trochanteric flip osteotomy and anterior dislocation (JBJS 83-B: 1119-1124, 2001). Diagnoses include slipped epiphysis 14, Perthes 12, aspherical head/ anterior offset 12, dysplasia 14, multiple exostoses 2, other 3.Seven patients had simultaneous femoral oste-otomies; four had subcapital osteotomies for epiphys-iolysis. All patients had pain and limitation of motion preoperatively, and more than fifty percent had severe deformity and/or some arthrosis. Follow-up was six months to five years. Ages at surgery were eight to forty-eight years (mean twenty years).

Results: The variety of pathologies render objective analysis difficult, though all patients reported greatly reduced pain and increased motion post operatively. Only five patients were totally pain free and had objectively totally normal hips. No patient felt unimproved. No patient had radiographic signs of osteonecrosis.

Conclusion: Paralleling the Bernese experience of more than eight hundred cases, we find the Bernese technique of surgical dislocation to be a safe, effective tool for treating intra-articular hip pathology, increasing treatment possibilities for hip joint preservation. We anticipate greatly expanding its use in the future.

We studied the pattern of proximal femoral growth after severe Perthes' disease (Catterall grade III or IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine the relationship between proximal femoral growth abnormalities and metaphyseal cysts, epiphyseal extrusion, physeal narrowing, and extensive epiphyseal necrosis. The average follow-up after treatment was 9.8 years (range 4 to 16 years), and 37 of the hips were followed to skeletal maturity. Slowing of proximal femoral growth was common: symmetrical abnormality was seen in 26 hips and asymmetrical abnormality in nine. However, definite premature closure of the proximal femoral physis was seen in only three hips. Abnormality seemed to be due to altered growth velocity rather than to bar formation in most cases. Metaphyseal cysts, epiphyseal extrusion and physeal narrowing during the active stage of the disease, alone or in combination, were found to be neither sensitive nor specific predictors of the subsequent growth pattern.