Periacetabular osteotomy for symptomatic hip dysplasia in middle aged patients: does age alone matter?

Background Conflicting evidence exists regarding outcomes in middle-aged patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip (DDH). Aims To compare patient reported outcomes (PROMs) of middle-aged PAO patients with younger patient groups. Methods Retrospective analysis of prospectively collected data of PAO patients between 01/2015 and 06/2017 at a single orthopedic university center with a primary diagnosis of symptomatic DDH. The cohort was divided into four age groups and compared: < 20, 20–30, 30–40 and > 40 years. Joint function was assessed using iHOT-12, mHHS and SHV. Activity level was assessed using UCLA Activity score. Patient satisfaction and pain were assessed on the numerical rating scale 0–10. Conversion rates to THA were assessed. Results Out of 202 PAOs, 120 cases with complete data were included. Mean follow-up was 63 months (range 47–81 months). Eighteen patients were < 20 years old, 54 were 20–30 years, 37 were 30–40 years, 11 patients were older than 40. No significant differences were observed for preoperative or postoperative iHOT-12 ( p = 0.898; p = 0.087), mHHS ( p = 0.878; p = 0.103), SHV ( p = 0.602; p = 0.352) or UCLA ( p = 0.539; p = 0.978) between groups. Improvement deltas were also not significantly different for all PROMs. Postoperative patient satisfaction was similar between groups ( p = 0.783). Conclusion Patients with symptomatic DDH may benefit from PAO even at middle age with similar outcomes and pre- to postoperative improvements as younger age groups. Indication should be based on biological age and preoperative joint condition rather than age.