Evaluation of Complications Associated with Periacetabular Osteotomy in Young Adult Patients

Background. Periacetabular osteotomy (PAO) is an effective method to prevent or delay the need for hip replacement surgery in young adults, though it carries a certain risk of complications. It is essential to study the factors influencing the complications rate in order to optimize surgical techniques and improve the outcomes. The aim of the study — to identify the incidence of postoperative complications and risk factors for their development in patients undergoing periacetabular osteotomy. Methods. The study included 82 patients (89 joints) with hip dysplasia (Crowe I-II grades, Hartofilakidis A and B types), operated between 2007 and 2023. The mean age of the participants was 30.90±8.71 years (95% CI: 29.02-32.79). We analyzed 178 X-rays and 58 CT scans performed one day before surgery and on day 1 after PAO. Radiographic parameters assessed included Wiberg angle, Tönnis angle, Sharp angle, femoral head extrusion index, index of sphericity of femoral head, and retroversion index. The CT scans were used to evaluate the values of AASA (anterior acetabular sector angle), PASA (posterior acetabular sector angle), HASA (horizontal acetabular sector angle), and AcetAV (acetabular anteversion angle). Results. Identified complications included acetabular overcorrection leading to pincer-type femoroacetabular impingement (24.72%), acetabular undercorrection (13.48%), stress fractures (16.85%), neurological impairments (8.99%), and infectious complications (3.37%). Patients with signs of overcorrection were 2.67 times more likely to require hip replacement (95% CI: 1.41-5.08). Undercorrection was associated with a 4.4-fold increase in arthroplasty risk (95% CI: 1.42-13.70; p = 0.013). An inverse relationship was found between the femoral head sphericity index and the likelihood of hip replacement following PAO: a 1% increase in this index reduced the odds of arthroplasty by 1.28 times (95% CI: 1.09-1.49). Conclusions. The key factors influencing hip joint survival after periacetabular osteotomy are the accuracy of acetabular correction and the degree of femoral head sphericity. To reduce the rate of complications, it is necessary to develop preoperative criteria for assessing joint congruity, as well as tools for precisely positioning of the acetabular fragment.