All ETDs from UAB

Advisory Committee Chair

Matthew P Ithurburn

Advisory Committee Members

Elroy J Aguiar

Donald D Lein Jr

Robert W Motl

Suzanne S Perumean-Chaney

Michael K Ryan

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Acetabular dysplasia (AD) is a condition of the hip joint that is characterized by incomplete acetabulum development leading to lack of bony coverage of the femoral head. As a result of intra-articular injury from lack of bony congruency, often, individuals with AD report hip joint instability, pain, decreased hip-related function, and are at high risk for early development of hip osteoarthritis (OA). AD is primarily affects young-to-middle-aged adults, is more common in females and those with history of a breech birth position. Periacetabular osteotomy (PAO) is the currently-recommended surgical treatment for AD that aims to reposition the acetabulum to increase hip joint congruency with the overall goal of minimizing pain and improving hip-related function. Current research has shown that patient-reported outcomes (PROs) significantly improve 6 months following PAO, yet early functional recovery and mobility-related outcomes have not been well-examined in individuals with AD before and after PAO. The current dissertation addressed these important research gaps via three independent studies. In study 1 (Chapter 2 of this dissertation; published in the Journal of Hip Preservation Surgery), and as a first step, we did a narrative review to synthesize the evidence regarding PROs and mobility-related outcomes in individuals with AD before and after PAO. Additionally, we identified important current research gaps and proposed recommendations for future studies. Briefly, we found that only PROs (pain, function, iv quality-of-life) significantly improved at 6 months after PAO. However, functional and mobility-related outcomes did not improve or change after PAO. Lastly, we found that few studies have examined mobility-related outcomes using real-world approaches such as using commercially-available wearables devices (e.g., accelerometers) to track recovery in individuals with AD following PAO. For studies 2 and 3 (chapters 3 and 4 of this dissertation), we used a prospective cohort study design to monitor changes in patient-reported and real-world outcomes over time in individuals with AD before and after PAO. We recruited potential participants from the practice of our clinical collaborator at the Hip Center at Andrews Sports Medicine and Orthopaedic Center in Birmingham, Alabama. We screened a total of 49 individuals with AD who were scheduled for PAO, of which 28 agreed to participate in our study. Data collected during study visits and remotely included: pain intensity, physical activity (PA) levels, lower extremity muscle strength, and movement patterns during dynamic, sports-related tasks before and 6 months after PAO. In study 2, we evaluated pain intensity before PAO, and at 1 week, and 1, 3, and 6 months after PAO using two valid and reliable pain-related questionnaires. Additionally, we evaluated device-measured PA levels using waist-worn accelerometers and self-reported PA using the International Physical Activity Questionnaire (IPAQ) before and 6 months after PAO. From the accelerometers, we calculated daily average time spent in sedentary behavior (SB), light PA, and moderate-to-vigorous physical activity (MVPA) as well as daily step counts. From the IPAQ, we calculated average time spent in walking and MVPA before and 6 months after PAO. We found that individuals reported significant reductions in pain intensity at 1 month and onward after PAO. Device-measured and self- v reported PA levels did not differ 6 months after PAO compared with pre-surgery levels. Self-reported MVPA was consistently higher than that measured by accelerometers, both before and 6 months after PAO. In study 3, we examined the influence of baseline rehabilitation-specific factors on pain intensity and PA levels 6 months after PAO. Specifically, we examined if lower extremity muscle strength and movement patterns during squat and countermovement jump (takeoff and landing phases) tasks before PAO explained variance in pain intensity and PA levels in individuals 6 months after PAO. Additionally, and as a secondary analysis, we examined the associations among pain intensity, PA levels, lower extremity muscle strength, and movement patterns in individuals 6 months after PAO. We used an isokinetic electrodynamometer to quantify lower extremity muscle strength and calculated peak torque for each muscle group (knee extensors and flexors; hip flexors, extensors, and abductors; Nm/Kg). We used two portable forceplates to quantify mean ground reaction force (mGRF) during the squat and CMJ takeoff and landing. Neither muscle strength nor movement/loading patterns before PAO influenced pain intensity or PA levels in individuals 6 months after PAO. Six months after PAO, we found that increased knee extensor strength symmetry was moderately correlated with increased time spent in MVPA and that hip extensor symmetry was moderately correlated with decreased time spent in light PA. Lastly, we found that increased hip abductor strength symmetry was moderately correlated with increased involved limb mGRF during CMJ landing. The findings from the current dissertation may guide clinicians and researchers working with individuals with AD undergoing PAO regarding PROs and real-world recovery, and what modifiable, clinical variables may play in role in recovery. The current vi dissertation represents a crucial first-step to inform the design of larger-scale studies to establish real-world outcomes and clinical interventions for those with AD undergoing PAO.

Available for download on Sunday, December 22, 2024