Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty.

BACKGROUND: Short-stem press-fit humeral components have recently been developed in an effort to preserve bone in total shoulder arthroplasty (TSA), but few studies have reported outcomes of these devices. The purpose of this study was to evaluate the short-term clinical outcomes of an anatomic short-stem humeral component in TSA. We hypothesized that the implant would lead to significant functional improvement with low rates of radiographic loosening. METHODS: A multicenter retrospective review was performed of TSAs using an anatomic short-stem humeral component (Apex; Arthrex, Inc., Naples, FL, USA). The minimum follow-up was 2 years. Functional outcome was evaluated according to the American Shoulder and Elbow Surgeons score, Visual Analog Scale for pain, Single Assessment Numeric Evaluation, Simple Shoulder Test, and range of motion. A radiographic analysis was performed to evaluate component loosening. RESULTS: Sixty-four patients with a mean age of 64.1 years were available for follow-up at a mean of 25 months postoperatively. There were significant improvements in the Visual Analog Scale (6 to 2; P < .001), Simple Shoulder Test (4 to 10; P < .001), Single Assessment Numeric Evaluation (32 to 84; P < .001), and American Shoulder and Elbow Surgeons (37 to 80; P < .001) scores. Forward flexion improved from 116° to 148° (P < .001), external rotation improved from 30° to 57° (P < .001), and internal rotation improved from an average spinal level of S1 to L2 (P < .001). On radiographic examination, 9% of stems were deemed at risk for loosening, but there was no gross loosening in any patient. CONCLUSIONS: TSA with an anatomic press-fit short-stem humeral component is associated with significant improvements in clinical outcomes, without evidence of component loosening at short-term follow-up.

Diagnosis and Management of the Biceps-Labral Complex.

The long head of the biceps tendon (LHBT) is a common source of pathology. The biceps-labral complex (BLC) is the collective anatomic and clinical features shared by the biceps tendon and the superior labrum. LHBT pathology can be caused by inflammation, instability, or trauma. Numerous tests can be performed to determine the existence of biceps tendon and superior labrum anterior to posterior (SLAP) lesions; however, many of these tests do not have high sensitivity and specificity, which limit their clinical utility. Because it is difficult to diagnose both LHBT and SLAP pathology, management strategies are best guided by a strong clinical suspicion and imaging findings on either MRI or ultrasonography. Initial nonsurgical management of LHBT and SLAP pathology includes focused physical therapy, anti-inflammatory medications, and corticosteroid injections. If nonsurgical management fails, surgical techniques for the management of LHBT pathology include biceps anchor reattachment (SLAP repair), biceps tenotomy, and biceps tenodesis. Techniques for biceps tenodesis, which can be performed in either an arthroscopic or open manner, include soft-tissue tenodesis, suprapectoral tenodesis, and subpectoral tenodesis. If appropriately managed, patients with LHBT pathology often have excellent clinical outcomes.

Functional results of bilateral reverse total shoulder arthroplasty.

BACKGROUND: The purpose of this study was to analyze a population of patients with bilateral reverse total shoulder arthroplasty (RTSA) to evaluate their ability to perform activities of daily living and personal hygiene tasks. METHODS: At a minimum 2-year follow-up, we retrospectively reviewed 50 patients (100 shoulders) with a mean age of 72 years who underwent staged bilateral RTSA. The average follow-up period was 61 months (range, 24-121 months), with a minimum 2-year follow-up after the second surgical procedure. Functional outcomes were assessed with American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Short Form 12 (SF-12) scores. In addition, a unique questionnaire regarding personal hygiene habits and activities of daily living reliant on shoulder rotation was administered to all patients. RESULTS: Patients showed significant improvements in pain (mean improvement in visual analog scale score from 5.7 to 1.0, P < .001) and forward elevation (mean improvement from 71° to 136°, P < .001). Clinical outcome scores showed significant improvements: The mean American Shoulder and Elbow Surgeons score improved from 35.8 to 76.5 (P < .001), Simple Shoulder Test score improved from 2.4 to 8.0 (P < .001), SF-12 mental component subscore improved from 51.9 to 54.1 (P < .001), and SF-12 physical component subscore improved from 30.5 to 39.7 (P < .001). Internal and external rotation showed significant improvements (from 33° to 53° [P < .005] and from 27° to 44° [P < .001], respectively). All patients retained independence with personal hygiene and activities of daily living. Complications included prosthetic instability (3%), acromial fracture (5%), and periprosthetic joint infection (1%). The overall reoperation rate was 5%. CONCLUSIONS: Bilateral RTSA provides predictable pain relief and improved function. Hygiene practices are unaltered for most patients, and the other patients rapidly develop simple compensatory strategies and retain independence in activities of daily living.

Patient factors influencing return to work and cumulative financial claims after clavicle fractures in workers' compensation cases.

BACKGROUND: This study analyzed workers' compensation patients after surgical or nonoperative treatment of clavicle fractures to identify factors that influence the time for return to work and total health care reimbursement claims. We hypothesized that return to work for operative patients would be faster. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and Current Procedural Terminology codes were used to retrospectively query the Workers' Compensation national database. The outcomes of interest were the number of days for return to full work after surgery and total reimbursement for health care-related claims. The primary independent variable was treatment modality. RESULTS: There were 169 claims for clavicle fractures within the database (surgical, n = 34; nonoperative, n = 135). The average health care claims reimbursed were $29,136 ± $26,998 for surgical management compared with $8366 ± $14,758 for nonoperative management (P < .001). We did not find a statistically significant difference between surgical (196 ± 287 days) and nonoperative (69 ± 94 days) treatment groups in their time to return to work (P = .06); however, there was high variability in both groups. Litigation was an independent predictor of prolonged return to work (P = .007) and higher health care costs (P = .003). CONCLUSION: Workers' compensation patients treated for clavicle fractures return to work at roughly the same time whether they are treated surgically or nonoperatively, with surgery being roughly 3 times more expensive. There was a substantial amount of variability in return to work timing by subjects in both groups. Litigation was a predictor of longer return to work timing and higher health care costs.

An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery.

PURPOSE: To identify risk factors of adult patients predisposing them to the most common complications that occur within 30 days after arthroscopic shoulder surgery. METHODS: The National Surgical Quality Improvement Program database was queried for arthroscopic shoulder procedures. Complications and their frequency were calculated. Multivariate analysis was used to identify risk factors of adult patients predisposing them to complications. Risk factors for reoperation and characteristics of patients undergoing repair procedures were also analyzed. RESULTS: Among 10,255 cases of shoulder arthroscopy, 119 complications were reported in 103 cases within 30 days of surgery. The rates of any, major, and minor complications were 1%, 0.57%, and 0.53%, respectively. Return to the operating room (29% of all complications) was the most frequent complication. With risk adjustment, the odds of complications developing were higher for patients older than 60 years (adjusted odds ratio [AOR], 3.47; P = .03), patients with a surgical time greater than 1.5 hours (AOR, 1.93; P = .01), patients with chronic obstructive pulmonary disease (COPD; AOR, 2.76; P = .03), patients with an inpatient status (AOR, 2.72; P < .01), patients with disseminated cancer (AOR, 21.9; P < .01), and current smokers (AOR, 1.94; P = .01). The presence of COPD (AOR, 4.67; P = .04) was a significant predictor for reoperation within 30 days. Repair procedures did not increase the risk of complications compared with non-repair. Male patients, patients aged younger than 30 years, nondiabetic patients, and nonsmokers were more likely to undergo repair procedures (P < .05 for all). CONCLUSIONS: Shoulder arthroscopy has a 1.0% thirty-day complication rate, with the most common complication being return to the operating room (29% of all complications). Age older than 60 years, surgical time greater than 90 minutes, COPD, inpatient status, disseminated cancer, and current smoking all increased a patient's risk of complications. Patients undergoing repair procedures were not at increased risk. Pulmonary comorbidity increases the risk of reoperation within 30 days. Patients undergoing repair procedures tend to be younger and carry fewer risk factors for complications. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Perioperative complications after hemiarthroplasty and total shoulder arthroplasty are equivalent.

BACKGROUND: Total shoulder arthroplasty (TSA) results in superior clinical outcomes to hemiarthroplasty (HA); however, TSA is a more technical and invasive procedure. This study retrospectively compares perioperative complications after HA and TSA using the National Surgical Quality Improvement Program (NSQIP) database. METHODS: The NSQIP user file was queried for HA and TSA cases from the years 2005 through 2010. Major complications were defined as life-threatening or debilitating. All complications occurred within 30 days of the initial procedure. We performed multivariate analysis to compare complication rates between the two procedures, controlling for patient comorbidities. RESULTS: The database returned 1,718 patients (HA in 30.4% [n = 523] and TSA in 69.6% [n = 1,195]). The major complication rates in the HA group (5.2%, n = 29) and TSA group (5.1%, n = 61) were similar (P = .706). Rates of blood transfusions for postoperative bleeding in patients undergoing HA (2.3%, n = 12) and TSA (2.9%, n = 35) were indistinguishable (P = .458). Venous thromboembolism was a rare complication, occurring in 0.4% of patients in each group (2 HA patients and 5 TSA patients, P > .999). On multivariate analysis, the operative procedure was not associated with major complications (P = .349); however, emergency case, pulmonary comorbidity, anemia with a hematocrit level lower than 36%, and wound class of III or IV increased the risk of a major complication (P < .05 for all). CONCLUSION: Multivariate analysis of patients undergoing TSA or HA in the NSQIP database suggests that patient factors-not the procedure being performed-are significant predictors of major complications. Controlling for patient comorbidities, we found no increased risk of perioperative major complications in patients undergoing TSA compared with HA.

A role for ATP-sensitive potassium channels in male sexual behavior.

ATP-sensitive potassium (K(+)(ATP)) channels regulate cell excitability and are expressed in steroid-responsive brain regions involved in sexual behavior, such as the preoptic area (POA) and medial basal hypothalamus (MBH). We hypothesized that K(+)(ATP) channels serve as a mechanism by which testosterone can control the electrical activity of neurons and consequently elicit male sexual responsiveness. RT-PCR analysis indicated that castration induces, while testosterone inhibits, mRNA expression of the K(+)(ATP) channel subunit Kir6.2 in both the POA and MBH of adult male rats. Intracerebral infusion of the pharmacological K(+)(ATP) channel inhibitor tolbutamide increased the proportion of long-term castrates displaying sexual behavior and restored mount frequency, intromission frequency, and copulatory efficacy to values observed in testes-intact animals. Infusions of tolbutamide, but not vehicle, also decreased latencies to mount and intromit in castrated males. Unilateral tolbutamide infusion directly into the POA significantly reduced mount latency of castrates; however, it did not affect other copulatory measures, suggesting that blockade of K(+)(ATP) channels in additional brain regions may be necessary to recover the full range of sexual behavior. These data indicate that blockade of K(+)(ATP) channels is sufficient to elicit the male sexual response in the absence of testosterone. Our observations are consistent with the hypothesis that testosterone modulates male sexual behavior by regulating K(+)(ATP) channels in the brain. Decreased channel expression or channel blockade may increase the excitability of androgen-target neurons, rendering them more sensitive to the hormonal, chemical, and somatosensory inputs they receive, and potentially increase secretion of neurotransmitters that facilitate sexual behavior.

Short-term Clinical Outcomes of Hemiarthroplasty With Concentric Glenoid Reaming: The Ream and Run Procedure.

The purpose of this study was to evaluate the short-term clinical and radiographic outcomes of humeral hemiarthroplasty and concentric glenoid reaming ("ream and run" procedure) and to compare the outcomes with those of total shoulder arthroplasty (TSA) for glenohumeral arthritis. Patients with glenohumeral arthritis who underwent the ream and run procedure with a minimum follow-up of 2 years were retrospectively reviewed. The primary outcome was revision to TSA. Secondary outcome measures included functional outcome scores, range of motion, and radiographic assessment. The outcome measures were compared with those of age- and sex-matched control patients who underwent anatomic TSA during the study period. One patient in the ream and run group required revision to TSA 14 months after the surgery because of excessive shoulder pain. There were significant improvements in the postoperative outcome scores and range of motion and external rotation in the ream and run group. Postoperative radiographs showed concentric glenoids without posterior subluxation in all except 1 shoulder. The outcome measures in the ream and run group were similar to those in the TSA control group except for active forward elevation and external rotation. The ream and run procedure provides improved pain relief and shoulder function at short-term follow-up for patients with shoulder arthritis. [Orthopedics. 2018; 41(6):e854-e860.].

Massive Rotator Cuff Tears: Trends in Surgical Management.

Compared with smaller tears, massive rotator cuff tears present significant clinical management dilemmas for the treating surgeon because they are often fraught with structural failure and poor outcomes. To optimize healing, current surgical methods look to optimize footprint coverage and enhance the biological environment for healing. Double-row techniques have demonstrated clear biomechanical advantages in controlled cadaveric studies, but have yet to demonstrate clear clinical efficacy over more simple repair techniques. When repairs for massive rotator cuff tears fail, options include revision repair or superior capsular reconstruction, an option to bridge the tissue gap with human dermal allograft or fascia lata autograft in hopes of containing the humeral head from superior migration and precluding rotator cuff arthropathy. Although latissimus transfers remain a reasonable option for massive, irreparable rotator cuff tears in appropriately indicated patients, clinical results are often unpredictable. Older patients with chronic, massive rotator cuff tears with pseudoparalysis can achieve predictable, often excellent clinical results with a reverse total shoulder arthroplasty. [Orthopedics. 2016; 39(3):145-151.].

Return to Play After Shoulder Surgery in Throwers.

The throwing athlete's shoulder is a unique, complex entity with challenges in diagnosis and management. The shoulders in these athletes possess unique biomechanics and pathologic conditions. Unfortunately, return to play outcomes are often poor when specifically evaluating overhead athletes, especially with regard to SLAP repair. It is imperative for the surgeon to be cautious when indicating these athletes for surgery, because although they may demonstrate improvements in pain and general function, subtle changes in accuracy or velocity as a result of surgery can significantly affect the success of an overhead throwing athlete at the competitive level.

Cost Drivers After Surgical Management of Proximal Humerus Fractures in Medicare Patients.

OBJECTIVES: This comparative effectiveness study sought to determine the impact of complications, readmission, and procedure choice on in-hospital and total 90-day costs for surgical management of proximal humerus fractures. METHODS: Medicare claims data from the Upstate New York area (2008-2009) were evaluated. The study included all patients treated with open reduction and internal fixation (ORIF) or hemiarthroplasty for proximal humerus fracture identified by ICD-9 codes. The primary end points included in-hospital costs and total health care costs within 90 days after the index operation. Multivariable generalized linear models with negative binomial distributions and log link function were used for cost analysis. RESULTS: ORIF was performed in 52 cases and hemiarthroplasty in 57 cases, total n = 109. On univariate analysis, readmission increased in-hospital cost by $54,345 and total 90-day costs by $63,104, whereas complications increased in-hospital cost by $23,300 and total 90-day costs by $30,237. On multivariable analysis, ORIF was associated with 29% lower in-hospital cost compared with hemiarthroplasty [Odds Ratio 0.71; 95% Confidence Interval (CI), 0.54-0.92; P = 0.01], and readmission was associated with a 5.68-fold in-hospital cost increase (Odds Ratio 5.68; CI, 3.57-9.03; P < 0.0001). CONCLUSIONS: Complications and hospital readmission continue to drive cost upward underscoring the need for best practice. The acute inpatient period costs may be decreased with ORIF in appropriately selected patients with proximal humerus fractures in comparison with hemiarthroplasty. This study provides real world cost estimates with the cost implications of complications, readmissions, and procedure choice. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Nonsurgical Management of Early-onset Scoliosis.

Early-onset scoliosis is potentially fatal if left untreated. Although surgical management with growing instrumentation may be necessary, this is not a panacea and is associated with high complication rates. Recent evidence has demonstrated that nonsurgical treatment can be an effective early management strategy in delaying or even precluding the need for surgery, especially surgery with growing instrumentation. The goal of both nonsurgical and surgical management is to control or correct the spinal curve to allow appropriate pulmonary development while delaying definitive fusion until an appropriate skeletal age. Although more commonly used to delay surgery, serial cast correction using the Cotrel and Morel elongation-derotation-flexion technique may result in complete correction in patients with infantile idiopathic scoliosis and smaller curve magnitudes.

Open reduction and internal fixation versus hemiarthroplasty in the management of proximal humerus fractures.

OBJECTIVES: The purpose of this study was to use a nationally representative database to determine the differences in 30-day outcomes based on procedure type for management of proximal humerus fractures including complications, readmission, operative time, and length of stay. Further, we sought to determine patient characteristics and perioperative factors associated with poor outcomes. DESIGN/SETTING: This was a retrospective study of the National Surgical Quality Improvement Program (NSQIP) database. The NSQIP comprises a clinical database with systematic patient tracking at multiple hospitals across the United States. PATIENTS: A total of 413 patients with proximal humerus fractures managed surgically were included. INTERVENTION: Of 413 patients, 330 underwent open reduction and internal fixation (ORIF) and 83 underwent hemiarthroplasty. MAIN OUTCOMES/MEASUREMENTS: The primary end points included major and minor complications, operative time, rate of return to the operating room, and length of stay. RESULTS: Compared to the hemiarthroplasty cohort, patients in the ORIF cohort were significantly younger (64.2; 17-90 and 69.3; 20-90, respectively, P = .007) and were significantly less likely to be of functionally dependent status (17.5% and 27.7%, P = .036). Compared to the hemiarthroplasty cohort, the ORIF cohort demonstrated fewer postoperative bleeding complications (2.4% and 8.4%, respectively, P = .016) and shorter operative times (115 vs 131 minutes, P = .017). There were no significant differences between the groups with respect to complications, reoperation rates, or length of hospital stay. On multivariable analysis, hemiarthroplasty demonstrated increased risk of postoperative bleeding compared to ORIF (odds ratio = 7.06, confidence interval: 2.06-24.24; P = .002) as well as increased operative time (P = .01). CONCLUSIONS: Patients who undergo hemiarthroplasty for management of proximal humerus fractures are significantly older and often functionally dependent. When compared to ORIF, hemiarthroplasty is associated with longer operative times and greater risk of bleeding complications.

Postoperative Morbidity by Procedure and Patient Factors Influencing Major Complications Within 30 Days Following Shoulder Surgery.

BACKGROUND: Little data are available to prioritize quality improvement initiatives in shoulder surgery. PURPOSE: To stratify the risk for 30-day postoperative morbidity in commonly performed surgical procedures about the shoulder completed in a hospital setting and to determine patient factors associated with major complications. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This retrospective study utilized the National Surgical Quality Improvement Program (NSQIP) database from the years 2005 to 2010. Using Current Procedural Terminology codes, the database was queried for shoulder cases that were divided into 7 groups: arthroscopy without repair; arthroscopy with repair; arthroplasty; clavicle/acromioclavicular joint (AC) open reduction and internal fixation (ORIF)/repair; ORIF of proximal humeral fracture; open tendon release/repair; and open shoulder stabilization. The primary end point was any major complication, with secondary end points of incisional infection, return to the operating room, and venothromboembolism (VTE), all within 30 days of surgery. RESULTS: Overall, 11,086 cases were analyzed. The overall major complication rate was 2.1% (n = 234). Factors associated with major complications on multivariate analysis included: procedure performed (P < .001), emergency case (P < .001), pulmonary comorbidity (P < .001), preoperative blood transfusion (P = .033), transfer from an outside institution (P = .03), American Society of Anesthesiologists (ASA) score (P = .006), wound class (P < .001), dependent functional status (P = .027), and age older than 60 years (P = .01). After risk adjustment, open shoulder stabilization was associated with the greatest risk of major complications relative to arthroscopy without repair (odds ratio [OR], 5.56; P = .001), followed by ORIF of proximal humerus fracture (OR, 4.90; P < .001) and arthroplasty (OR, 4.40; P < .001). These 3 groups generated over 60% of all major complications. Open shoulder stabilization had the highest odds of reoperation (OR, 8.34; P < .001), while ORIF of proximal humerus fracture had the highest risk for VTE (OR, 6.47; P = .001) compared with the reference group of arthroscopy without repair. CONCLUSION: Multivariable analysis of the NSQIP database suggests that open shoulder stabilization, ORIF for proximal humerus fractures, and shoulder arthroplasty are associated with the highest risk of major complications within 30 days after shoulder surgery in a hospital setting. Age, functional status, ASA score, pulmonary comorbidity, emergency case, preoperative blood transfusion, and transfer from an outside institution are patient variables that significantly influence complication risk.

Proximal humerus fractures with associated axillary artery injury.

Proximal humerus fractures have rarely been associated with injuries to the axillary artery. Most of the fractures described have been Neer 2-part surgical neck fractures with medialization of the shaft fragment and resultant laceration or thrombosis of the axillary artery. No intraoperative deaths have been reported. We present a series of 3 proximal humerus fractures, 2 of which are Neer 3- to 4-part anterior fracture dislocations, and associated axillary artery injury. There were 2 mortalities, 1 intraoperative. After a thorough review of the English literature, we identified an additional 11 cases of axillary artery injury associated with proximal humerus fracture. The purpose of this study was to heighten the clinical suspicion of this vascular injury in patients with proximal humerus fracture dislocations and surgical neck fractures with shaft medialization, as well as to review pathogenesis and guide management decisions.

Functional and imaging outcomes of arthroscopic simultaneous rotator cuff repair and bankart repair after shoulder dislocations.

BACKGROUND: Previous studies have investigated outcomes of simultaneous rotator cuff (RC) repair and superior labral injury repair; however, there is limited information in the literature on outcomes of simultaneous RC repair and Bankart lesion repair after acute shoulder dislocations. PURPOSE: To determine functional and imaging outcomes of simultaneous arthroscopic RC repair and Bankart repair after acute shoulder dislocations and to compare functional outcomes to contralateral, asymptomatic shoulders. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Consecutive patients who underwent arthroscopic simultaneous RC repair and Bankart repair with a minimum of 2 years' follow-up were recruited. All patients had suffered an acute shoulder dislocation. The American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Short Form (SF)-36 scores were obtained. The affected shoulder also underwent ultrasound imaging to assess the integrity of the RC. RESULTS: Thirteen patients (mean age, 58.8 ± 11.2 years; mean follow-up, 38.5 ± 12.3 months) were recruited. In a comparison of the affected versus unaffected shoulder, there were no significant differences in the mean ASES score (89.7 ± 12.6 vs 95.0 ± 6.7, respectively), mean Constant score (80.5 ± 18.9 vs 86.8 ± 7.9, respectively), or mean abduction strength (15.4 ± 6.4 lb vs 15.4 ± 5.2 lb, respectively) (P > .05). The mean SF-36 physical component summary was 48.4. According to ultrasound imaging, there were persistent/recurrent full-thickness tears in 4 patients, and 1 patient had a new full-thickness tear. At follow-up, patients with full-thickness RC tears in the affected shoulder compared with their unaffected shoulder showed similar mean ASES scores (90.9 ± 11.8 vs 97.6 ± 4.3, respectively), mean Constant scores (77.8 ± 20.3 vs 84.8 ± 7.2, respectively), and mean abduction strength (11.5 ± 5.3 lb vs 12.6 ± 4.5 lb, respectively) (P > .05). CONCLUSION: After simultaneous arthroscopic repair of the RC and a Bankart lesion in patients after shoulder dislocations, the affected extremity had similar functional outcomes compared to the noninjured, asymptomatic side at a mean of 3 years after surgery. Persistent or recurrent RC tears involving the operative extremity were common, but they did not significantly affect functional outcomes in this small study.

Periacetabular osteotomy and combined femoral head-neck junction osteochondroplasty: a minimum two-year follow-up cohort study.

BACKGROUND: Proximal femoral deformities and overcorrection of the acetabulum both can result in secondary femoroacetabular impingement and suboptimal clinical results after periacetabular osteotomy. The purpose of the present study was to determine the rate of complications, the need for reoperations, radiographic correction, and hip function among patients who underwent periacetabular osteotomy and combined femoral head-neck osteochondroplasty as compared with those who underwent periacetabular osteotomy alone. METHODS: Patients who underwent periacetabular osteotomy with or without osteochondroplasty of the femoral head-neck junction were evaluated retrospectively after a minimum duration of follow-up of two years. We compared the two groups with regard to the modified Harris hip score, radiographic correction, complications, and reoperations. RESULTS: Forty patients (forty hips) who underwent periacetabular osteotomy in conjunction with a femoral head-neck osteochondroplasty were compared with forty-eight patients (forty-eight hips) who underwent an isolated periacetabular osteotomy. Patients were evaluated after a mean duration of follow-up of 3.4 years (range, 2.0 to 9.7 years). Preoperatively, the modified Harris hip score (and standard deviation) was 64.3 ± 13.2 for the study group and 63.2 ± 13.4 for the comparison group. At the time of the latest follow-up, the modified Harris hip score was not significantly different between the study group and the comparison group (p = 0.17). Patients demonstrated equivalent preoperative deformities and postoperative acetabular radiographic parameters. There was a significant decrease in the alpha angle and improvement in head-neck offset in the study group. There was one reoperation for secondary impingement and/or labral pathology in the study group, compared with four reoperations in the comparison group. There were no adhesions requiring surgery, femoral neck fractures, instances of osteonecrosis, or increases in heterotopic ossification in the study group. CONCLUSIONS: Femoral head-neck junction osteochondroplasty performed concurrently with a periacetabular osteotomy for the treatment of symptomatic acetabular dysplasia and associated femoral head-neck junction deformities is not associated with an increased complication rate. This combined procedure provides effective correction of associated femoral head-neck deformities and produces similar early functional outcomes when compared with isolated periacetabular osteotomy. LEVEL OF EVIDENCE: Therapeutic Level III.