{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:29Z","timestamp":1787755289718,"version":"build-2784847793"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,3,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The treatment of hip dysplasia in patients with Down syndrome is challenging. We investigated the clinical, functional, and radiographic outcomes of periacetabular osteotomy (PAO) as well as factors associated with its failure at a minimum of 5 years of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Between 1992 and 2011, 19 patients with Down syndrome (26 hips) underwent PAO at a mean age of 16.2 \u00b1 4.7 years. Hip pain and function were assessed with use of the modified Harris hip score (HHS) and the Gross Motor Function Classification System (GMFCS). The criteria for PAO failure were progression of osteoarthritis with a recommendation for total hip arthroplasty or hip arthrodesis, or an HHS of &lt;60 points. Preoperative and most recent radiographs were assessed for measurement of the lateral and anterior center-edge angles, T\u00f6nnis angle, extrusion index, and anterior and posterior wall indices, and for evaluation of the T\u00f6nnis grade of osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At an average follow-up of 13.1 \u00b1 5.2 years (range, 5.4 to 24 years), 13 (62%) of 21 hips with an HHS demonstrated good or excellent HHS results (median, 91 points; interquartile range, 65 to 96 points). Ninety-five percent of the patients were independent in ambulation. All radiographic parameters significantly improved after PAO. Eight (31%) of the 26 hips were considered to have failed the procedure. T\u00f6nnis grade-2 osteoarthritis (4 hips compared with 1 hip; p = 0.008; odds ratio [OR] = 17.00) and older patient age at the time of the procedure (19.6 \u00b1 6.7 compared with 14.7 \u00b1 2.4 years; p = 0.017; OR = 1.36 per year) were demonstrated to be factors associated with PAO failure in an analysis of hips that failed compared with those without failure at the time of latest follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>PAO improves radiographic deformity and helps to preserve independent ambulation in patients with hip dysplasia and Down syndrome. Although nearly 70% of the hips were preserved at an average of 13 years postoperatively, 1 in 3 hips met the criteria for failure, which was associated with older age at the time of the procedure and a moderate osteoarthritis grade (T\u00f6nnis grade 2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00957","type":"journal-article","created":{"date-parts":[[2018,3,7]],"date-time":"2018-03-07T16:48:40Z","timestamp":1520441320000},"page":"428-434","source":"Crossref","is-referenced-by-count":9,"title":["Mid-Term Results of Periacetabular Osteotomy for the Treatment of Hip Dysplasia Associated with Down Syndrome"],"prefix":"10.2106","volume":"100","author":[{"given":"Daniel A.","family":"Maranho","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Millis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-3100","authenticated-orcid":false,"given":"Eduardo N.","family":"Novais","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (K.A.W.), Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"4","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1302\/0301-620X.75B4.8331117","article-title":"Hip disease in adults with Down syndrome","volume":"75","author":"Hresko","year":"1993","journal-title":"J Bone Joint Surg Br."},{"issue":"5","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/BPO.0000000000000484","article-title":"Hip instability in Down syndrome: a focus on acetabular retroversion","volume":"36","author":"Abousamra","year":"2016","journal-title":"J Pediatr Orthop."},{"issue":"3","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/BPO.0b013e31824b27fc","article-title":"Acetabular retroversion in Down syndrome","volume":"32","author":"Sankar","year":"2012","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1097\/01241398-200311000-00005","article-title":"Posterior acetabular wall deficiency in Down syndrome","volume":"23","author":"Woolf","year":"2003","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1097\/BPO.0b013e3182285fa5","article-title":"Femoral varus derotation osteotomy for the treatment of habitual subluxation and dislocation of the pediatric hip in trisomy 21: a 10-year experience","volume":"31","author":"Knight","year":"2011","journal-title":"J Pediatr Orthop."},{"key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/00003086-199205000-00016","article-title":"The hip joint in Down\u2019s syndrome. 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