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Risk Factors Associated With Nonunion Following Periacetabular Osteotomy for
Treatment of Symptomatic Hip Dysplasia
#MMPMID41210902
Beyer RSH
; Goodspeed DC
; Call CJ
; Mosiman SJ
; Spiker AM
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41210902
show ga
BACKGROUND: Nonunion of an osteotomy site is one of the most reported
complications following periacetabular osteotomy (PAO). Identification of risk
factors for nonunion is an important area of research as hip preservation has an
increasing presence in orthopaedic surgery. METHODS: We retrospectively
identified patients who underwent PAO between March 2018 and May 2023 with a
minimum of 1-year follow-up. Twelve-month postoperative radiographs were reviewed
to determine the prevalence of nonunion. Descriptive statistics and mixed-effects
logistic regression models were run. RESULTS: Ninety-four hips (84 patients) were
included. 84.5% of patients (n = 71) were female, average age was 28.2 (±9.8)
years and body mass index (BMI) was 25.4 (±4.3) kg/m(2). 15 of 94 hips (16.0%)
were nonunited at the superior ramus osteotomy, and 2 of these hips (2.1%) also
had an ischial nonunion. All nonunions occurred in female patients. The mean age
of healed hips was 26.7 ± 9.5 years compared with 35.7 ± 8.1 years for nonunion
(p = 0.016). BMI was higher in the nonunion group (healed 24.8 ± 4.0, nonunion
27.7 ± 4.3 kg/m(2); p = 0.048). Hounsfield unit at the femoral neck on
preoperative computed tomograpy was 220.7 ± 77.3 in healed hips and 167.6 ± 49.6
for nonunion (p = 0.047). Average distance from the ilioischial line to the most
medial aspect of the femoral head was 5.6 ± 5.7 mm in healed hips and 1.7 ± 5.2
mm for nonunion (p = 0.047). CONCLUSIONS: Risk factors of nonunion include older
age, lower bone mineral density at the femoral neck, greater acetabular fragment
medialization, and higher BMI. Our findings reinforce the importance of
preoperative risk assessment and patient counseling, particularly for older,
higher BMI, female patients. Intraoperative modifications, including making a
more lateral superior ramus osteotomy and minimizing excessive acetabular
fragment medialization, may help mitigate nonunion risk. LEVEL OF EVIDENCE: Level
III. See Instructions for Authors for a complete description of levels of
evidence.
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