Early postoperative complications following periacetabular osteotomy: a single-center cohort study on 1,356 consecutive procedures
DOI:
https://doi.org/10.2340/17453674.2025.44402Keywords:
Hip, Pelvis and acetabulumAbstract
Background and purpose: Periacetabular osteotomy (PAO) is a major surgical procedure, yet data on early postoperative complications and hospitalizations remains limited. We aimed to report postoperative complications within 90 days using the modified Clavien-Dindo classification system. Our secondary aim was to report the peri- and postoperative complications observed in patients with length of hospital stay (LOS) exceeding 4 days or readmitted within 90 days following PAO.
Methods: We identified patients who underwent PAO at a single institution between 2006 and 2021. Patient characteristics, LOS, in-hospital complications, and readmissions within 90 days postoperatively were obtained from our institutional database, patient files, and the Danish National Patient Registry to ensure complete follow up. Minor complications were defined as Clavien-Dindo grades 1 and 2, while major complications were defined as grades 3 and 4.
Results: 1,356 consecutive PAO procedures were performed in 1,096 patients with a mean age of 29.3 years (SD 11.1) and 77% females. Minor complications occurred in 499 hips (37%, 95% confidence interval [CI] 35–39) within 90 days of PAO. Only 16 (1.2%, CI 0.6–1.8) major complications were observed. LOS exceeded 4 days in 244 cases (18%) most frequently linked with nausea and emesis in 40 (2.9%). The 90-day readmission rate was 4.4% (CI 2.6–6.2), most commonly linked with pain in 11 (1.0%) and wound infection requiring antibiotics also in 11 (1.0%).
Conclusion: PAO was associated with 37% minor complications within 90 days, while major complications were rare, occurring in only 1.2% of cases. After 18% of PAO procedures, LOS exceeded 4 days, and the 90-day readmission rate was 4.4%.
Downloads
References
Ganz R, Klaue K, Vinh T S, Mast J W. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. Clin Orthop Relat Res 1988; (232): 26-36. DOI: https://doi.org/10.1097/00003086-198807000-00006
Rosendahl Kristiansen A, Holsgaard-Larsen A, Bøgehøj M, Overgaard S, Lindberg-Larsen M, Ovesen O. Hip survival after periacetabular osteotomy in patients with acetabular dysplasia, acetabular retroversion, congenital dislocation of the hip, or Legg–Calvé–Perthes disease: a cohort study on 1,501 hips. Acta Orthop 2023; 94: 250-6. doi: 10.2340/17453674.2023.12403. DOI: https://doi.org/10.2340/17453674.2023.12403
Ganz R, Leunig M, Leunig-Ganz K, Harris W H. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 2008; 466(2): 264-72. doi: 10.1007/s11999-007-0060-z. DOI: https://doi.org/10.1007/s11999-007-0060-z
Harris W H. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 1986; (213): 20-33. DOI: https://doi.org/10.1097/00003086-198612000-00004
Morris W Z, Justo P G S, Williams K A, Kim Y J, Millis M B, Novais E N. The incidence and risk factors for stress fracture following periacetabular osteotomy. Bone Joint J 2022; 104-b(9): 1017-24. doi: 10.1302/0301-620x.104b9.Bjj-2021-1391.R3. DOI: https://doi.org/10.1302/0301-620X.104B9.BJJ-2021-1391.R3
Steinthorsdottir K J, Awada H N, Dirks J, Stürup J, Winther N S, Kehlet H, et al. Early post-operative recovery after peri-acetabular osteotomy: a double-blind, randomised single-centre trial of 48 vs. 8 mg dexamethasone. Eur J Anaesthesiol 2021; 38(Suppl 1): S41-s9. doi: 10.1097/eja.0000000000001410, DOI: https://doi.org/10.1097/EJA.0000000000001410
Tan S H S, Tan J H I, Lim A K S, Hui J H. Periacetabular osteotomy for acetabular retroversion: a systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107(8): 103078. doi: 10.1016/j.otsr.2021.103078, DOI: https://doi.org/10.1016/j.otsr.2021.103078
Wells J, Schoenecker P, Petrie J, Thomason K, Goss C W, Clohisy J C. Are complications after the Bernese periacetabular osteotomy associated with subsequent outcomes scores? Clin Orthop Relat Res 2019; 477(5): 1157-63. doi: 10.1097/corr.0000000000000566. DOI: https://doi.org/10.1097/CORR.0000000000000566
von Elm E, Altman D G, Egger M, Pocock S J, Gøtzsche P C, Vandenbroucke J P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guide-lines for reporting observational studies. Ann Intern Med 2007; 147(8): 573-7. doi: 10.7326/0003-4819-147-8-200710160-00010. DOI: https://doi.org/10.7326/0003-4819-147-8-200710160-00010
Hussell J G, Mast J W, Mayo K A, Howie D W, Ganz R. A comparison of different surgical approaches for the periacetabular osteotomy. Clin Orthop Relat Res 1999; (363): 64-72. PMID: 10379306. DOI: https://doi.org/10.1097/00003086-199906000-00009
Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sørensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-90. doi: 10.2147/clep.S91125. DOI: https://doi.org/10.2147/CLEP.S91125
Sink E L, Leunig M, Zaltz I, Gilbert J C, Clohisy J. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 2012; 470(8): 2220-6. doi: 10.1007/s11999-012-2343-2. DOI: https://doi.org/10.1007/s11999-012-2343-2
Dindo D, Demartines N, Clavien P A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2): 205-13. doi: 10.1097/01.sla.0000133083.54934.ae. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae
Lie S A, Engesaeter L B, Havelin L I, Gjessing H K, Vollset S E. Dependency issues in survival analyses of 55,782 primary hip replacements from 47,355 patients. Stat Med 2004; 23(20): 3227-40. doi: 10.1002/sim.1905. DOI: https://doi.org/10.1002/sim.1905
Tønning L U, O’Brien M, Semciw A, Stewart C, Kemp J L, Mechlenburg I. Periacetabular osteotomy to treat hip dysplasia: a systematic review of harms and benefits. Arch Orthop Trauma Surg 2023; 143(6): 3637-48. doi: 10.1007/s00402-022-04627-7. DOI: https://doi.org/10.1007/s00402-022-04627-7
Zaltz I, Baca G, Kim Y J, Schoenecker P, Trousdale R, Sierra R, et al. Complications associated with the periacetabular osteotomy: a prospective multicenter study. J Bone Joint Surg Am 2014; 96(23): 1967-74. doi: 10.2106/jbjs.N.00113. DOI: https://doi.org/10.2106/JBJS.N.00113
Lazar D B D, Ovesen O, Bøgehøj M, Overgaard S. The incidence and risk factors of pelvic stress fracture, delayed-healing and non-union following periacetabular osteotomy in adolescents. Arch Orthop 2024; 4(1): 13-19. doi: 10.33696/Orthopaedics.4.032 DOI: https://doi.org/10.33696/Orthopaedics.4.032
Wainwright T W, Gill M, McDonald D A, Middleton R G, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. Acta Orthop 2020; 91(1): 3-19. doi: 10.1080/17453674.2019.1683790. DOI: https://doi.org/10.1080/17453674.2019.1683790
Fujita J, Doi N, Kinoshita K, Seo H, Doi K, Yamamoto T. Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy. Bone Joint J 2024; 106-b(5 Supple B): 11-16. doi: 10.1302/0301-620x.106b5.Bjj-2023-0621.R1. DOI: https://doi.org/10.1302/0301-620X.106B5.BJJ-2023-0621.R1
Beck E C, Gowd A K, Paul K, Chahla J, Marquez-Lara A J, Rasio J, et al. Pelvic osteotomies for acetabular dysplasia: are there outcomes, survivorship and complication differences between different osteotomy techniques? J Hip Preserv Surg 2020; 7(4): 764-76.10.1093/jhps/hnab009: [10.1093/jhps/hnab009]. DOI: https://doi.org/10.1093/jhps/hnab009
Novais E N, Carry P M, Kestel L A, Ketterman B, Brusalis C M, Sankar W N. Does surgeon experience impact the risk of complications after Bernese periacetabular osteotomy? Clin Orthop Relat Res 2017; 475(4): 1110-17. doi: 10.1007/s11999-016-5010-1. DOI: https://doi.org/10.1007/s11999-016-5010-1
Additional Files
Published
How to Cite
License
Copyright (c) 2025 Anne R Kristiansen, Ole Ovesen, Martin H Haubro, Anders Holsgaard-Larsen, Søren Overgaard, Martin Lindberg-Larsen
This work is licensed under a Creative Commons Attribution 4.0 International License.
