Clinical Long-term Outcomes after Modified Pemberton Acetabuloplasty for Developmental Dysplasia of the Hip: a 25-Year Follow-up

Abstract

Background

Developmental dysplasia of the hip (DDH) is among the most common congenital musculoskeletal disorders and may lead to early hip osteoarthritis if left untreated. Modified Pemberton acetabuloplasty is an established, growth-preserving osteotomy technique for surgical correction in childhood. However, robust clinical long-term outcomes with follow-up periods exceeding two decades have not yet been published. The aim of this study was to retrospectively evaluate functional and patient-reported outcomes after an average follow-up of 25.6 years.

Methods

In this monocentric retrospective cohort study, 63 patients (92 hips) were included from an original cohort of 331 patients with 507 operated hips who had undergone modified Pemberton acetabuloplasty between 1990 and 1995. In 2018, clinical follow-up was performed in 54 patients; all participants completed standardised questionnaires, including the Harris Hip Score (HHS), WOMAC, and EQ-5D. Data analysis was descriptive.

Results

The mean follow-up period was 25.6 years. The average HHS was 95.8 points, the mean WOMAC index 7.2 points, and the EQ-5D-VAS 89.3/100. A total of 81% of patients were free of symptoms, and 83.3% achieved excellent functional results. Overall, 96.8% rated the surgical outcome as good or very good, and 92% would choose to undergo the procedure again. No patient required total hip arthroplasty. No major postoperative complications occurred.

Conclusion

Modified Pemberton acetabuloplasty demonstrates stable functional outcomes, low symptom levels, and high health-related quality of life more than 25 years after surgery. The very high patient satisfaction and the absence of secondary procedures underscore the long-term clinical effectiveness of this growth-preserving technique.

Keywords

developmental dysplasia of the hip - Pemberton osteotomy - acetabuloplasty - long-term outcome - WOMAC

Publication History

Received: 01 July 2025

Accepted after revision: 17 December 2025

Article published online:
13 February 2026

• References

• 1 Shaw BA, Segal LS. et al. Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics 2021; 138: e20163107
• 2 Tönnis D. Die angeborene Hüftdysplasie und Hüftluxation im Kindes- und Erwachsenenalter. Berlin, Heidelberg: Springer; 1984
• 3 Kayser R, Witt HJ, Franke J. et al. Sonographische Diagnostik und sonographiegestützte Therapie der Hüftdysplasie im Säuglingsalter. Manuelle Medizin 2007; 45: 159-166
• 4 Pothmann M, Cordier W. Protrahierte Hüftreifungsstörung im Kindesalter. In: Tschauner C. , ed. Orthopädie und Orthopädische Chirurgie – Becken, Hüfte. Stuttgart: Thieme; 2004: 141-155
• 5 Tschauner C, Hofmann S. Residuelle Hüftdysplasie. In: Tschauner C. , ed. Orthopädie und Orthopädische Chirurgie – Becken, Hüfte. Stuttgart: Thieme; 2004: 156-169
• 6 Alshryda S, Banaszkiewicz PA. Developmental Dysplasia of the hip. In: Alshryda S, Jones S, Banaszkiewicz PA. , ed. Postgraduate Paediatric Orthopaedics: The Candidate’s Guide to the FRCS(Tr&Orth) Examination. Cambridge: Cambridge University Press; 2024: 66-85
• 7 Pemberton P. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J. Bone Joint Surg 1965; 47: 65-86
• 8 Bonmann R. Ergebnisse der Azetabuloplastik in der modifizierten Dortmunder Technik mit allogenen, autoklavierten Knochenkeilen in einem postoperativen Zeitraum von acht bzw. neun Jahren [Dissertation]. Gießen: Justus-Liebig-Universität Gießen; 2003
• 9 Debrunner HU, Hepp WR. Orthopädisches Diagnostikum. 6. Stuttgart: Thieme; 1994
• 10 Ruchholtz S, Wirtz D. Orthopädie und Unfallchirurgie essentials. 4. Stuttgart: Thieme; 2012
• 11 Buckup K. Klinische Tests an Knochen, Gelenken und Muskeln. 4. Stuttgart: Thieme; 2008
• 12 Brüning K, Heinecke A, Tönnis D. Langzeitergebnisse der Azetabuloplastik. Z Orthop Ihre Grenzgeb 1988; 126: 266-273
• 13 Reichel H, Haunschild M, Hein W. Langzeitresultate der Azetabuloplastik nach Dega. Z Orthop Unfall 1996; 134: 131-136
• 14 Thielemann F, Schneider A, Köhler T. et al. Langfristige Behandlungsergebnisse der Azetabuloplastik nach Pemberton in Kombination mit einer intertrochantären Derotations-Varisationsosteotomie bei der Hüftdysplasie im Kindesalter. Z Orthop Unfall 2003; 141: 459-464
• 15 Panagiotopoulou N, Bitar K, Hart WJ. The association between mode of delivery and developmental dysplasia of the hip in breeth infants: a systemic review of 9 cohort studies. Acta Orthop Belg 2012; 78: 697-702
• 16 Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 2000; 8: 232-242
• 17 Meurer A, Eckhardt A, von Recklinghausen P. Die Indikation zur pericapsulären Iliumsoteotomie nach Pemberton. Orthop Praxis 1994; 30: 614-617
• 18 Baki ME, Baki C, Aydin H. et al. Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip. J Pediatr Orthop B 2016; 25: 504-508
• 19 Ezirmik N, Yildiz K. A study on the complications of surgical treatment for bilateral developmental dysplasia of the hip and a comparison of two osteotomy techniques. Eurasian J Med 2011; 43: 162-168
• 20 Davidson D, Yen YM, Jette AM. et al. Responsiveness of the SF-36 and WOMAC following periacetabular osteotomy for acetabular dysplasia. J Bone Joint Surg Am 2011; 93: 2214-2218
• 21 Seror R, Tubach F, Baron G. et al. Individualizing the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) function subscale: incorporating patient priorities for improvement to measure functional impairment in hip or knee osteoarthritis. Ann Rheum Dis 2008; 67: 494-499
• 22 Goronzy J, Franken L, Hartmann A. et al. What Are the Results of Surgical Treatment of Hip Dysplasia With Concomitant Cam Deformity?. Clin Orthop Relat Res 2017; 475: 1128-1137
• 23 Franken LCA. Behandlungsergebnisse nach periazetabulärer Beckenosteotomie mit und ohne Korrektur einer femoralen Cam-Deformität [Dissertation]. Dresden: Technische Universität Dresden; 2016