Age at Periacetabular Osteotomy Does Not Reduce the Likelihood of Excellent 20-Year Patient-Reported Outcomes in Native Hips: A K-Means Clustering Analysis.
Academic Article
Overview
abstract
BACKGROUND: Periacetabular osteotomy (PAO) is widely used to treat symptomatic hip dysplasia; however, the long-term effect of age at PAO on patient-reported outcome measures (PROMs) remains controversial. We aimed to determine whether age at PAO influences long-term PROMs. METHODS: We conducted a retrospective cohort study involving 111 patients (126 hips) who had a mean follow-up of 19.5 years after PAO. The Forgotten Joint Score-12 (FJS-12) and Oxford Hip Score (OHS) were collected via postal survey. Patients were clustered into three groups using k-means clustering based on PROMs. A cluster with the highest scores-exceeding the patient acceptable symptom state threshold for FJS-12 and showing differences beyond minimal clinically important difference-was defined as "excellent." The remaining native hips and those converted to total hip arthroplasty (THA) were grouped as controls. Multivariable logistic regressions identified indicators of excellent outcomes. RESULTS: The "excellent" group (n = 64) had mean scores of FJS-12: 84.1 and OHS: 46.6. The control group (n = 93) included native hips with lower PROMs and 31 hips converted to THA. The mean age at PAO was 41 years in the excellent group and 44 years in controls (P = 0.133). Age at PAO was not a negative indicator of excellent outcomes (adjusted odds ratio (OR) per year, 1.02; 95% confidence interval (CI), 0.98 to 1.06). Using Tönnis Grade 1 as a reference, Grade 0 was a positive indicator (OR 3.35; 95% CI, 1.16 to 10.5), and Grade 2 was a negative indicator (OR 0.13; 95% CI, 0.04 to 0.37). Higher BMI was also a negative indicator (OR per unit, 0.83; 95% CI, 0.73 to 0.94). CONCLUSION: Age at PAO does not reduce the likelihood of excellent 20-year PROMs in native hips. Therefore, age alone should not be a limiting factor when considering PAO in appropriately selected patients.
