{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:08:47Z","timestamp":1790132927668,"version":"4.0.1"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,5,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Periacetabular osteotomy (PAO) is the most common treatment for symptomatic acetabular dysplasia, or developmental dysplasia of the hip (DDH), in skeletally mature patients. The purpose of this multicenter cohort study was to delineate the long-term radiographic natural history of the dysplastic hip following PAO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We evaluated all patients undergoing PAO from 1996 to 2012 at 3 academic institutions in the United States. Inclusion criteria were PAO for DDH with a minimum 5-year radiographic follow-up. Exclusion criteria were PAO for isolated acetabular retroversion, neurogenic dysplasia, Legg-Calv\u00e9-Perthes disease, and prior hip surgery including osteotomies and arthroscopy. There were 288 patients, 83% of whom were women; the mean age and body mass index (BMI) were 29 years and 25 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively. The mean clinical and radiographic follow-up was 9.2 years (range, 5.0 to 21.1 years). Every preoperative and postoperative hip radiograph was assessed to determine the degree of osteoarthritis according to the T\u00f6nnis classification. Survivorship was analyzed by multistate modeling, enabling assessment of progression through the T\u00f6nnis grades rather than just individual transitions as with Kaplan-Meier techniques.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At the time of final follow-up, 144 patients (50%) had progressed at least 1 T\u00f6nnis grade, with 42 patients (14.6%) undergoing total hip arthroplasty. The mean number of years spent in each T\u00f6nnis grade following PAO was 19 for T\u00f6nnis grade 1, 8 for T\u00f6nnis grade 2, and 4 for T\u00f6nnis grade 3. The probability of progression to total hip arthroplasty increased significantly on the basis of a higher initial T\u00f6nnis grade (p &lt; 0.001). The most marked difference occurred between T\u00f6nnis grade 0 or 1 and T\u00f6nnis grade 2; for T\u00f6nnis grade 1, the probability of progression to total hip arthroplasty at 5 and 10 years was 2% and 11%, respectively, compared with 23% and 53%, respectively, for T\u00f6nnis grade 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>PAO effectively alters the natural history of DDH. Precise radiographic progression based on the T\u00f6nnis grade can now be used to ascribe prognosis for the native hip. Importantly, this investigation demonstrates a stark increase in progression to total hip arthroplasty within 10 years of PAO for patients with preoperative T\u00f6nnis grade-2 osteoarthritis compared with those with T\u00f6nnis grade-0 or 1 osteoarthritis.<\/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.18.00983","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T07:28:43Z","timestamp":1557991723000},"page":"932-938","source":"Crossref","is-referenced-by-count":98,"title":["Natural History of the Dysplastic Hip Following Modern Periacetabular Osteotomy"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8629-7567","authenticated-orcid":false,"given":"Cody C.","family":"Wyles","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-6382","authenticated-orcid":false,"given":"Juan S.","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5196-8527","authenticated-orcid":false,"given":"Mark J.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8783-0191","authenticated-orcid":false,"given":"Kristin C.","family":"Mara","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9608-3346","authenticated-orcid":false,"given":"Christopher L.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7040-616X","authenticated-orcid":false,"given":"John C.","family":"Clohisy","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4572-7540","authenticated-orcid":false,"given":"Robert T.","family":"Trousdale","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-1477","authenticated-orcid":false,"given":"Rafael J.","family":"Sierra","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/00003086-198807000-00006","article-title":"A new periacetabular osteotomy for the treatment of hip dysplasias. 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