Increased complications of periacetabular osteotomy in the obese patient is not a contraindication

TL;DR

Obese patients undergoing periacetabular osteotomy experience similar pain reduction and radiographic improvement as non-obese patients, despite higher complication risks.

Contribution

The study challenges the notion that obesity is a contraindication for PAO by showing comparable pain relief and radiographic outcomes.

Findings

Obese patients had a statistically significant higher incidence of complications compared to non-obese patients.

There was no significant difference in pain reduction or radiographic improvement between obese and non-obese patients.

PAO provides significant pain relief and quality of life improvement for obese patients despite increased complication risks.

Abstract

Periacetabular osteotomy (PAO) is performed to relieve symptomatic acetabular dysplasia by reorienting the acetabulum to provide adequate femoral head coverage. Due to an increased risk for complications in obese patients, some surgeons consider obesity as a contraindication for surgery. We theorize obese patients will have similar reductions in their pain levels and improvement in radiographic parameters despite an increased risk for postoperative complications. We performed a retrospective review of all patients who underwent a PAO in the last 12 years by the principal investigator. The incidence of complications, change in visual analogue scale (VAS) scores at 6 months follow up, and change in lateral centre edge angles (LCEAs) were then compared between obese patients and non-obese patient cohorts. Forty-eight hips in 41 patients were analysed. Fifteen hips were of obese patients at time of operation and 33 hips were of non-obese patients. The number of complications in the obesity group was statistically significant with a P value of .04, while the number of reoperations was not with a P value of .11. There was no significant difference in VAS score preoperatively (P = .37) and postoperatively (P = .26) between patient cohorts. There was no significant difference in LCEA preoperatively (P = .35) and postoperatively (P = .26). While obese patients are at increased risk for complication, they have a similar reduction in pain compared to the non-obese cohort. PAO in obese patients will provide a significant reduction in patient’s acetabular pain and subsequently improve their quality of life.