Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?

Abstract

Background:

Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear.

Purpose:

To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d’Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO.

Results:

The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4.

Conclusion:

Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.

Keywords

acetabular dysplasia osteoarthritis periacetabular osteotomy transposition osteotomy of the acetabulum sports progression of the OA stage

Get full access to this article

View all access options for this article.

References

American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30(6):975-991.

Amstutz

Thomas

Jinnah

Kim

Grogan

Yale

. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66(2):228-241.

Beaulé

Dowding

Parker

Ryu

J-J

. What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2015;473(2):615-622.

Bogunovic

Hunt

Prather

Schoenecker

Clohisy

. Activity tolerance after periacetabular osteotomy. Am J Sports Med. 2014;42(8):1791-1795.

Bradley

Moul

Doyle

Wilson

. Return to sporting activity after total hip arthroplasty: a survey of members of the British Hip Society [published online September 28, 2016]. J Arthroplasty. doi:10.1016/j.arth.2016.09.019.

Clohisy

Schutz

St John

Schoenecker

Wright

. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467(8):2041-2052.

Delimar

Cicak

Klobucar

Pećina

Korzinek

. Acetabular roof reconstruction with pedicled iliac graft. Int Orthop. 2002;26(6):344-348.

Ettinger

Berger

Floerkemeier

Windhagen

Ezechieli

. Sports activity after treatment of residual hip dysplasia with triple pelvic osteotomy using the Tonnis and Kalchschmidt technique. Am J Sports Med. 2015;43(3):715-720.

Fitzpatrick

. Questionnaire on the perceptions of patients about total hip replacement: reply. J Bone Joint Surg Br. 1996;78(5):856.

10.

Fujii

Nakashima

Noguchi

et al . Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. J Bone Joint Surg Br. 2011;93(11):1449-1456.

11.

Gray

Stambough

Baca

Schoenecker

Clohisy

. Comparison of contemporary periacetabular osteotomy for hip dysplasia with total hip arthroplasty for hip osteoarthritis. Bone Joint J. 2015;97(10):1322-1327.

12.

Hamai

Nakashima

Akiyama

et al . Ischio-pubic stress fracture after peri-acetabular osteotomy in patients with hip dysplasia. Int Orthop. 2014;38(10):2051-2056.

13.

Hasegawa

Iwase

Kitamura

Yamauchi

Ki K

Sakano

Iwata

. Eccentric rotational acetabular osteotomy for acetabular dysplasia: follow-up of one hundred and thirty-two hips for five to ten years. J Bone Joint Surg Am. 2002;84(3):404-410.

14.

Hasegawa

Masui

Yamaguchi

Kawabe

Suzuki

. Factors leading to osteoarthritis after eccentric rotational acetabular osteotomy. Clin Orthop Relat Res. 2007;459:207-215.

15.

Heyworth

Novais

Murray

et al . Return to play after periacetabular osteotomy for treatment of acetabular dysplasia in adolescent and young adult athletes. Am J Sports Med. 2016;44(6):1573-1581.

16.

Ito

Tanino

Yamanaka

Minami

Matsuno

. Intermediate to long-term results of periacetabular osteotomy in patients younger and older than forty years of age. J Bone Joint Surg Am. 2011;93(14):1347-1354.

17.

Japanese Ministry of Health, Labour and Welfare. Annual Health, Labour and Welfare Report: 2013-2014 (Summary). Available at: http://www.mhlw.go.jp/english/wp/wp-hw8/dl/summary.pdf. Accessed February 9, 2017.

18.

Kaneuji

Sugimori

Ichiseki

Fukui

Takahashi

Matsumoto

. Rotational acetabular osteotomy for osteoarthritis with acetabular dysplasia: conversion rate to total hip arthroplasty within twenty years and osteoarthritis progression after a minimum of twenty years. J Bone Joint Surg Am. 2015;97(9):726-732.

19.

Kellgren

Lawrence

. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502.

20.

Klein

Levine

Hozack

et al . Return to athletic activity after total hip arthroplasty: consensus guidelines based on a survey of the Hip Society and American Association of Hip and Knee Surgeons. J Arthroplasty. 2007;22(2):171-175.

21.

Liechti

Ferguson

Tannast

. Protrusio acetabuli: joint loading with severe pincer impingement and its theoretical implications for surgical therapy. J Orthop Res. 2015;33(1):106-113.

22.

Matheney

Zaltz

Kim

Y-J

et al . Activity level and severity of dysplasia predict age at Bernese periacetabular osteotomy for symptomatic hip dysplasia. J Bone Joint Surg Am. 2016;98(8):665-671.

23.

Matsuo

Jingushi

Nakashima

et al . Transposition osteotomy of the acetabulum for advanced-stage osteoarthritis of the hips. J Orthop Sci. 2009;14(3):266-273.

24.

Naal

Impellizzeri

Eisenhart-Rothe von

Mannion

Leunig

. Reproducibility, validity, and responsiveness of the hip outcome score in patients with end-stage hip osteoarthritis. Arthritis Care Res. 2012;64(11):1770-1775.

25.

Nakamura

Ninomiya

Takatori

Morimoto

Umeyama

. Long-term outcome of rotational acetabular osteotomy: 145 hips followed for 10-23 years. Acta Orthop Scand. 1998;69(3):259-265.

26.

Nakashima

Fujii

Noguchi

et al . Arthroscopic validation of radiographic minimum joint space width associated with the subchondral bone exposure in symptomatic hip dysplasia [published online September 2, 2016]. Mod Rheumatol. doi:10.1080/14397595.2016.1222663.

27.

Nilsdotter

Bremander

. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopaedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res. 2011;63(S11):S200-S207.

28.

Novais

Heyworth

Murray

Johnson

Kim

Y-J

Millis

. Physical activity level improves after periacetabular osteotomy for the treatment of symptomatic hip dysplasia. Clin Orthop Relat Res. 2013;471(3):981-988.

29.

Ollivier

Frey

Parratte

Flecher

Argenson

. Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement. Bone Joint J. 2014;96(8):1041-1046.

30.

Surgeon General’s report on physical activity and health. From the Centers for Disease Control and Prevention. JAMA. 1996;276(7):522.

31.

Teratani

Naito

Kiyama

Maeyama

. Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am. 2010;92(1):31-41.

32.

Uesugi

Makimoto

Fujita

Nishii

Sakai

Sugano

. Validity and responsiveness of the Oxford Hip Score in a prospective study with Japanese total hip arthroplasty patients. J Orthop Sci. 2009;14(1):35-39.

33.

van Bergayk

Garbuz

. Quality of life and sports-specific outcomes after Bernese periacetabular osteotomy. J Bone Joint Surg Br. 2002;84(3):339-343.

34.

Yasunaga

Ochi

Yamasaki

Shoji

Izumi

. Rotational acetabular osteotomy for pre- and early osteoarthritis secondary to dysplasia provides durable results at 20 years. Clin Orthop Relat Res. 2016;474(10):2145-2153.

35.

Yasunaga

Takahashi

Ochi

et al . Rotational acetabular osteotomy in patients forty-six years of age or older: comparison with younger patients. J Bone Joint Surg Am. 2003;85(2):266-272.