Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes

Objective: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiographs remain standard for evaluating acetabular coverage, 3-dimensional (3D) computed tomography (CT)-based measurements using acetabular sector angles (ASAs) provide higher precision. This study aimed to analyze acetabular coverage through ASA parameters and to investigate the long-term clinical outcomes following PAO. Methods: This retrospective study included 35 hips from 29 patients who underwent PAO for DDH. Radiographic measurements comprised the T.nnis angle, Sharp angle, lateral center-edge angle (LCEA) and anterior center-edge angles (ACEA), anterior center margin angle (ACMA), extrusion index, and hip lateralization index (HLI). The CT-derived variables included acetabular version (AV), anterior ASA (AASA), posterior ASA (PASA), and horizontal ASA (HASA). Clinical outcomes were assessed by using the Harris Hip Score (HHS). Results: The mean patient age was 19.9 years, with a mean follow-up period of 8.7 years. Significant postoperative improvements were noted in AASA, HASA, T.nnis angle, Sharp angle, extrusion index, AV, LCEA, ACEA, acetabular depth, and HHS (all P < .05). No significant differences were observed in PASA, HLI, or ACMA. The HHS showed a negative correlation with HLI (P < .05) and a positive correlation with postoperative LCEA (P < .01). Patients with postoperative LCEA < 25Åã demonstrated superior functional outcomes compared with those with LCEA ≥ 35Åã (P = .034). Eight patients experienced complications, and 2 patients required conversion to total hip arthroplasty. Conclusion: The PAO provides durable long-term results in the management of DDH. Incorporating 3D ASA analysis enhances both preoperative planning and postoperative evaluation, contributing to more precise acetabular reorientation and improved clinical assessment Cite this article as: Güneş Z, Çağlar Ö, et al. Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes. Acta Orthop Traumatol Turc., 2026; 60(1), 0334, doi: 10.5152/j.aott.2026.25334