Triple-Osteotomy leads to substantially improved quality of life in patients with hip dysplasia

Abstract

Purpose

Triple-Osteotomy (TO) is a hip-preserving surgical technique designed to correct symptomatic hip dysplasia by achieving three-dimensional acetabular reorientation and improving femoral head coverage. This procedure has shown promising outcomes in pain reduction, functional recovery, and quality of life, particularly in young, active patients. While periacetabular-osteotomy (PAO) is another well-established method for hip preservation, the specific advantages of TO, especially in early recovery and patient-reported outcomes (PROMs), remain underexplored. This study evaluates the mid-term outcomes of TO using the iHOT33 tool to provide a comprehensive understanding of its clinical benefits.

Methods

This non-randomised, retrospective registry study within the German Cartilage Registry included 48 patients with symptomatic, radiologically confirmed hip dysplasia who underwent TO by the same specialist. The follow-up rate at 24 months was 60.4% with a mean follow-up time of 24 months. Outcomes measured included iHOT33 scores, quality of life, VAS for pain, satisfaction, perceived treatment benefit, and unemployment rate. Paired t-tests and regression analysis (p < 0.05) were applied.

Results

Preoperative iHOT33 scores averaged 46.9, increasing to 70.8 after 24 months (Δ 23.9), with notable improvement in the first 6 months (Δ 15.8). The “social” subdomain showed the greatest improvements (Δ 30 points), alongside improvements in quality of life and pain reduction (VAS). Postoperative angles (VCE 31° ± 4°, acetabular index 0° ± 3°) were within the normal range. No significant correlation was found between angle changes and iHOT33 scores, indicating benefits across dysplasia severities.

Conclusions

Triple-osteotomy offers significant and rapid improvements in patient-reported outcomes for individuals with hip dysplasia, particularly in enhancing social and sports-related quality of life as measured by iHOT33 and other subjective assessments. Its potential advantages over Periacetabular-osteotomy, especially in terms of early recovery, warrant further investigation through prospective, comparative studies to better define its role in hip-preserving surgical strategies.

Level of Evidence

Level III.