FP2.4 Who Needs AIIS Decompression After PAO? Preoperative Imaging Predictors of Subspine Impingement

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ID: 331285
2026
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Abstract
Abstract ICLA02 - Demystifying the Deformed Hip: Practical Principles of Pelvic and Femoral Osteotomies, Auditorium A (BMCC Level 1), October 8, 2026, 10:30 - 12:30 Background Anterior inferior iliac spine (AIIS) morphology may contribute to iatrogenic femoracetabular impingement following periacetabular osteotomy (PAO). Persistent subspine impingement often requires AIIS decompression, but imaging predictors remain unknown. The purpose of this study is to determine whether pre-operative radiographic and cross-sectional imaging parameters predict the need for AIIS decompression after PAO. Methods This retrospective cohort study included skeletally mature patients aged 13- 39 years who underwent PAO for idiopathic dysplasia at a single institution by two high-volume hip preservation surgeons between 2022-2025. Patients with any prior history of bony surgery were excluded. The need for AIIS recession was determined intra-operatively based upon range-of-motion exam post-PAO and fluoroscopic/tactile evidence of impingement. Pre-operative imaging metrics (radiographs and CT) were independently completed by two observers using previously described, validated measures of acetabular coverage, version, femoral-head lateralization, femoral-neck morphology, head-neck offset and AIIS morphology (Hetsroni classification). Additionally, we developed and validated 8 novel measures further describing AIIS morphology in the coronal, sagittal, and axial planes. Using LASSO regression, models were developed to identify the optimal predictor set based on the validated measures (first model), novel measures (second model), and then after combining optimal predictors sets from the first two models (third model) to evaluate which model carried the greatest predictive capacity for future AIIS decompression. Results The final cohort (n=71) included n=31 patients who underwent intra-operative AIIS recession (mean [SD] age=20.1 [4.9] years, 100% female) and n=40 who underwent PAO alone (19.2 [5.5] years, 92.5% female). Examined in isolation, all imaging parameters demonstrated poor-to-fair predictive capacity (c-statistic=0.50-0.68). The first model selected 13 validated measures for inclusion: c-statistic=0.78 (95%CI=0.67-0.89) with good calibration (calibration-slope=1.21, standard error [SE] 0.27). The second model selected 4 novel measures: c-statistic=0.76 (95%CI=0.65-0.88) with good calibration (calibration-slope=1.12; SE=0.26). Combining these models (n=5 validated, n=2 novel; third model) yielded the greatest prognostic capacity: c-statistic=0.83 (95%CI=0.73-0.93) with good calibration (calibration-slope=1.13; SE=0.20). Conclusion Although individual pre-operative imaging parameters did not reliably predict the need for AIIS decompression after PAO, a combination of validated and novel measures demonstrated promising ability to quantify individual-level risk of AIIS decompression during PAO. These hold promise as a preliminary tool for pre-operative planning and identifying patients at risk for subspine impingement.
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Authors DO Sonja Hedblom, MD Julia LaMonica, Matthew J. Hartwell, MD Ira Zaltz, DO Steven Soliman, PhD Daniel Whitney, MD Alex Gornitzky
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.012
URL
https://doi.org/10.1093/jhps/hnag043.012
Keywords Keywords not found

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