BACKGROUND Developmental dysplasia of the hip (DDH) can cause pain and premature osteoarthritis. The risk factors and timing for disease progression in adolescents and young adults have not been fully defined. This study aimed to determine the prevalence of and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on a dysplastic hip. METHODS Patients undergoing unilateral PAO for DDH were followed for at least 2 years and categorized into contralateral pain and no-pain groups and contralateral surgery and no-surgery groups. Pain was defined with the modified Harris hip score. Univariate analysis tested group differences in demographics, radiographic measures, and range of motion. Kaplan-Meier survival analysis was used to assess pain development and surgery in the contralateral hip over time. Multivariable regression identified risk factors for contralateral pain and surgery. Contralateral pain and surgery predictors were secondarily assessed after categorization of the contralateral hips as dysplastic, borderline, and non-dysplastic and in subgroups based on the lateral center-edge angle (LCEA) and acetabular inclination (AI) in 5° increments. RESULTS One hundred and eighty-four patients were followed for a mean of 4.6 ± 1.6 years (range, 2.0 to 8.8 years), during which 51% (93) reported contralateral hip pain and 33% (60) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% with contralateral pain development as the end point and 66% with contralateral surgery as the end point. Painful hips exhibited more severe dysplasia compared with no-pain hips (LCEA = 16.5° versus 20.3°, p < 0.001; AI = 13.2° versus 10.0°, p < 0.001). AI was the sole predictor of pain, with every 1° increase in the AI raising the risk by 11%. Surgically treated hips also had more severe dysplasia (LCEA = 14.9° versus 20.0°, p < 0.001; AI = 14.7° versus 10.2°, p < 0.001) and were in younger patients (21.6 versus 24.1 years, p = 0.022). AI and a maximum alpha angle of ≥55° were predictors of contralateral surgery. CONCLUSIONS At 5 years after hip PAO, approximately 50% of contralateral hips will have pain and approximately 35% can be expected to need surgery. More severe dysplasia, based on the LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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使用对侧髋关节模型确定髋关节发育不良疾病进展的危险因素。


背景 发育性髋关节发育不良 （DDH） 可引起疼痛和过早的骨关节炎。青少年和年轻人疾病进展的危险因素和时间尚未完全确定。本研究旨在确定发育不良髋关节髋关节截骨术 （PAO） 后对侧髋关节疼痛和手术的患病率和危险因素。方法 对接受单侧 PAO 治疗 DDH 的患者随访至少 2 年，分为对侧疼痛组和无痛组以及对侧手术组和无手术组。疼痛用改良的 Harris 髋关节评分定义。单变量分析测试了人口统计学、放射学测量和运动范围的组别差异。Kaplan-Meier 生存分析用于评估对侧髋关节疼痛发展和手术随时间的变化。多变量回归确定了对侧疼痛和手术的危险因素。在将对侧髋关节分类为发育不良、交界性和非发育不良后，以及根据外侧中心边缘角 （LCEA） 和髋臼倾斜度 （AI） 以 5° 为增量的亚组，对侧疼痛和手术预测因子进行二次评估。结果 184 例患者平均随访 4.6 ± 1.6 年 （范围，2.0 至 8.8 年），在此期间，51% （93） 报告对侧髋关节疼痛，33% （60） 接受对侧手术。Kaplan-Meier 分析预测以对侧疼痛发展为终点的 5 年生存率为 49%，以对侧手术为终点的 5 年生存率为 66%。与无痛髋关节相比，疼痛的髋关节表现出更严重的异型增生 （LCEA = 16.5° vs 20.3°，p < 0.001;AI = 13.2° 对 10.0°，p < 0.001）。 AI 是疼痛的唯一预测指标，AI 每增加 1°C，风险就会增加 11%。手术治疗的髋关节也有更严重的异型增生 （LCEA = 14.9° vs 20.0°，p < 0.001;AI = 14.7° vs 10.2°，p < 0.001），并且见于年轻患者 （21.6 岁 vs 24.1 岁，p = 0.022）。AI 和最大 α 角 ≥55° 是对侧手术的预测因子。结论 髋关节 PAO 后 5 年，约 50% 的对侧髋关节会感到疼痛，预计约 35% 的髋关节需要手术。基于 LCEA 和 AI 的更严重的异型增生会增加对侧髋关节疼痛和手术的风险，AI 是这两种结果的预测指标。了解这些风险可以为患者咨询和治疗计划提供信息。证据级别 预后 III 级。有关证据级别的完整描述，请参阅作者说明。