Return to Sport and Outcomes After Periacetabular Osteotomy With Concomitant Hip Arthroscopy in Athletes: Minimum 5-Year Follow-up

Abstract

Background:

Periacetabular osteotomy (PAO), concomitant with hip arthroscopy, used as treatment for symptomatic hip acetabular dysplasia, has shown favorable outcomes at midterm follow-up. However, limited literature has evaluated outcomes and return to sport (RTS) rates in athletes with concomitant PAO and hip arthroscopy.

Purpose/Hypothesis:

The purpose of this study was to analyze functional outcomes and RTS rates of athletes who underwent PAO with concomitant hip arthroscopy for symptomatic hip dysplasia with a minimum 5-year follow-up. It was hypothesized that athletes undergoing PAO with concomitant hip arthroscopy would show favorable outcomes and high rates of RTS.

Study Design:

Case series; Level of evidence, 4.

Methods:

Retrospectively analyzed data for all patients who underwent PAO concomitant with hip arthroscopy as treatment for painful hip dysplasia between November 2010 and December 2018. Included patients reported sports participation and had completed preoperative and a minimum of 5-year postoperative questionnaires for at least 1 of the following patient-reported outcomes (PROs): the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and patient satisfaction, or had a documented endpoint during the study timeframe. Clinically important thresholds were included in the analysis. An overall RTS analysis was conducted, and continuation of sport was analyzed at a minimum of 5 years postoperatively.

Results:

A total of 28 patients (n = 29 hips) were included. Patients experienced significant improvements in mHHS, NAHS, HOS-SSS, iHOT-12, and VAS scores, and reported high patient satisfaction. A high percentage of patients reached the minimal clinically important difference for the evaluated PROs and reported a positive response to the patient acceptable symptom state anchor question. Of the 28 patients, 3 chose to stop playing due to lifestyle changes or loss of interest in the sport, 3 stopped because of a desire to prevent hip symptoms, and 1 stopped because of a doctor’s recommendation. Among the remaining 21 patients who attempted to RTS, 18 (85.7%) returned to sports at some time postoperatively. Three patients (14.3%) did not return due to persistent hip symptoms. Moreover, of those who returned to sport, 14 (77.8%) continued to play for a minimum of 5 years postoperatively. Four hips (13.8%) required revision hip arthroscopy, and 1 (3.4%) underwent conversion to total hip arthroplasty.

Conclusion:

PAO with concomitant hip arthroscopy for symptomatic hip dysplasia resulted in significant improvements in functional outcomes, with a high percentage of patients achieving important clinical thresholds. There was a high rate of RTS, enabling a substantial number of patients to continue playing at a minimum 5-year follow-up.