Clinical outcomes of 3D-guided Ganz periacetabular osteotomy for hip Dysplasia: Advances in preoperative planning and cartilage augmentation

Developmental dysplasia of the hip (DDH) is characterized by insufficient acetabular coverage, leading to joint instability, altered biomechanics, and an increased early-onset osteoarthritis risk. Periacetabular osteotomy (PAO), particularly Ganz osteotomy, is a joint-preserving procedure that reorients the acetabulum to restore coverage and improve hip stability. PAO has been shown to provide clinical benefits; however, recent advancements in 3D-guided preoperative planning and cartilage augmentation techniques may further optimize surgical outcomes and expand indications for PAO hip preservation. The outcomes of 3D-guided Ganz PAO performed at a single center were retrospectively reviewed. Preoperative and postoperative radiographic parameters, including lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), and Tönnis angle were assessed to evaluate improvements in acetabular coverage. Additional intraoperative modifications, including preoperative cyst localization, cartilage scaffold implantation (Biphasic Cartilage Repair Implant, BiCRI), and cyst augmentation were recorded. Nineteen patients (mean age 38 years) underwent 3D-guided Ganz PAO, of which 6 patients (32%) also received implantation of a cartilage scaffold and 4 (21%) received cyst augmentation. Mean preoperative Harris Hip Score (HHS) was 48, increasing to 92 at 3 months and 96 at 6 months postoperatively. At postoperative 6 months, 13 patients (68%) were rated an "Excellent" outcome, 4 (21%) "Good," and 2 (11%) "Acceptable." 3D-guided PAO with cartilage augmentation can achieve favorable short-term radiographic correction and functional improvement, even in patients with complex acetabular pathology. Prospective studies with extended follow-up are needed to clarify the durability and broader applicability of these techniques in hip preservation.