TP1.1 Periacetabular Osteotomy for Developmental Dysplasia of the Hip in Patients Aged 40 Years and Older Achieves Clinical and Radiographic Outcomes Equivalent to Younger Patients

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ID: 331019
2026
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Abstract
Abstract Background Periacetabular osteotomy (PAO) represents the standard hip preserving procedure for developmental dysplasia of the hip (DDH). However, age ≥40 years is frequently considered a relative contraindication, and the impact of advanced age on clinical and radiographic outcomes remains debated despite standardized surgical techniques. This study aimed to evaluate whether patients aged ≥40 years achieve non-inferior and equivalent outcomes to younger patients following PAO, using formal equivalence testing. Methods We retrospectively reviewed 124 consecutive patients with DDH (Tönnis grade ≤2) who underwent PAO between August 2014 and December 2024. Patients were stratified into a middle-aged group (≥40 years) and a younger group (<40 years). The primary endpoints were postoperative Harris Hip Score (HHS) and International Hip Outcome Tool-12 (iHOT-12). Equivalence margins were predefined as ±8 points for HHS and ±13 points for iHOT-12. Analysis of covariance (ANCOVA) was used to compute adjusted mean differences and 90% confidence intervals (CIs), accounting for confounding variables. Multivariable logistic regression was performed to assess the independent effect of age on achieving minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and perioperative complications. Results Mean follow-up was 2.9 years in the younger group and 2.7 years in the middle-aged group (P>0.05). After adjustment for confounders, the adjusted mean difference was −0.38 (90% CI −3.58 to 2.82) for HHS and 1.44 (90% CI −3.69 to 6.56) for iHOT-12. Both 90% CIs were fully contained within the predefined equivalence margins, confirming clinical equivalence. Preoperative and postoperative radiographic parameters, including Tönnis angle and lateral center-edge angle (LCEA), were comparable between groups (all P>0.05). These findings suggest that patients in the middle-aged group did not demonstrate more severe baseline radiographic deformity and that the degree of surgical correction was comparable between the groups. Multivariable regression demonstrated that age ≥40 years was not an independent risk factor for failing to achieve MCID or PASS for either HHS or iHOT-12 (all P>0.05). Rates of osteoarthritis progression, perioperative metrics (blood loss, hospital stay), and complications (nerve injury, thromboembolism, surgical site infection, posterior column fracture) were similar between groups (all P>0.05). Conclusion In patients with DDH and mild osteoarthritis (Tönnis grade ≤2), PAO in those aged 40 years and older provides equivalent radiographic correction and functional improvement with no increased perioperative risk compared with younger patients. Age alone should not be used as an exclusion criterion for PAO. With appropriate patient selection, middle-aged patients can derive substantial benefit from hip preserving surgery.
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Authors Hanjun Fang, Yifan Guo, Haiyuan Zeng, Jindian Zhan, Zhiwen Chen, Yinuo Fan, Huang Zeqing, Hongyu Tang, Hong Zhang, Zhenqiu Chen
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.137
URL
https://doi.org/10.1093/jhps/hnag043.137
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