Midterm Outcomes of Reverse (Anteverting) Periacetabular Osteotomy in Patients with Hip Impingement Secondary to Acetabular Retroversion

Background: There is a paucity of data on the results of reverse (anteverting) periacetabular osteotomy (RPAO) for treatment of femoroacetabular impingement (FAI) secondary to acetabular retroversion. Purpose: To evaluate the midterm outcomes of RPAO for FAI secondary to acetabular retroversion in those with and without hip dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review identified RPAOs performed on patients with acetabular retroversion in isolation or in the setting of dysplasia (lateral center-edge angle [LCEA] ≤19°). Acetabular retroversion with FAI was diagnosed clinically and radiographically, with a positive crossover and posterior wall signs on pelvic radiographs. Twenty-three patients (30 hips) met the inclusion criteria; 20 hips with isolated retroversion and 10 hips with retroversion and hip dysplasia. The average age at the time of the procedure was 26 years (range, 13-45 years). The average length of follow-up was 5 years (range, 2-19 years). Harris Hip Score (HHS) and radiographs were evaluated preoperatively and at last follow-up. Results: The mean preoperative LCEA was 31° (range, 22°-49°) in the isolated retroversion group and 9° (range, -4° to 17°) in the dysplastic group. Postoperatively, the LCEA in the dysplastic group increased to 35° (range, 15°-46°) (P =.0001). The crossover sign corrected in 55% (11/20) of the isolated retroversion group and 80% (8/10) of the dysplastic group. The acetabular index (mean ± SD) improved from 1.3 ± 0.3 to 1.7 ± 0.6 (P =.0001), indicating improved anteversion. At the latest follow-up, the average HHS in the isolated retroversion group increased from 58 preoperatively (range, 23-77) to 93 (range, 68-100) (P =.0001); the HHS in the dysplastic group improved from 49 (range, 20-74) to 92 (range, 77-100) (P <.0001). Complication rates were similar in both groups. Excluding hardware removal, additional surgeries were performed in 13% (4/30). Conclusion: RPAO performed for FAI in the young patient with isolated acetabular retroversion or retroversion in the setting of dysplasia successfully improved clinical and radiographic results at mid- to long-term follow-up.