Periacetabular osteotomy provides durable correction and low arthroplasty conversion at  ≥ 7 years: prospective middle eastern study

BACKGROUND: Long-term prospective data on periacetabular osteotomy (PAO) from Middle Eastern populations are limited. This study evaluated ≥ seven year clinical, functional, and radiographic outcomes following PAO and identified predictors of survivorship. METHODS: Thirty-six consecutive patients (34.6 ± 7.2 years; 78% female) undergoing PAO (2014-2018) were prospectively followed. Inclusion required symptomatic dysplasia with Tönnis 0-2. Outcomes included HHS, WOMAC, HOS, SF-36, radiographic parameters (LCEA, AI), complications, and THA conversion. Reliability, multivariate regression, and Kaplan-Meier analyses were performed. RESULTS: At 7.8 ± 1.2 years, HHS improved from 63.5 ± 11.2 to 89.6 ± 7.8 (p < 0.001). LCEA increased from 16.2 ± 4.3° to 31.8 ± 3.9° and AI decreased from 22.8 ± 5.1° to 7.2 ± 3.6°. ICC for measurements was 0.92. Complications occurred in 16.7% (mostly minor). THA conversion was 5.6%, both with preoperative Tönnis 2 and correction < 12°. Magnitude of LCEA correction independently predicted HHS improvement (β = 0.41, p < 0.01). CONCLUSIONS: PAO achieved durable correction and sustained functional improvement with low THA conversion at mid- to long-term follow-up. Preoperative cartilage status and adequacy of correction are key determinants of outcome.