Bernese Periacetabular Osteotomy Improves Patient Reported Outcomes in Patients with Charcot-Marie Tooth Disease with No Detrimental Effect on Gait

Background Charcot-Marie-Tooth disease (CMT) is a common hereditary neuropathy associated with an ∼8% incidence of hip dysplasia. The impact of corrective surgery, specifically, the effect of Bernese periacetabular osteotomy (PAO) on patient reported outcomes (PRO) and postoperative gait parameters in CMT has not been reported. This study aimed to analyze the short-term postoperative gait, clinical, radiographic, and functional outcomes after PAO in CMT patients with symptomatic hip dysplasia. Methods This was a retrospective review of a consecutive series of CMT patients undergoing PAO. Included patients had a diagnosis of CMT, symptomatic acetabular dysplasia, and minimum 1 year follow-up. Radiographic measures included lateral and ventral center-edge angles (LCEA, VCEA), Tönnis angle, and medialization index. Gait was assessed using 3D motion capture with kinetic analysis and compared with an age-matched control cohort. Patient-reported outcomes included the Harris Hip Score (HHS) and UCLA activity score. Results Nine hips in seven patients (mean age at surgery 15.9 years) were included. After PAO, radiographic parameters improved significantly: mean LCEA from –20.3° to 11.2° (p=0.014), VCEA from –27.2° to 18.8° (p=0.016), Tönnis angle from 38.3° to 15.6° (p=0.014), and medialization index from 68.8 to 33.3 (p=0.008). At 1-year follow-up, HHS improved from 69.5 to 84.46 (p=0.026), whereas UCLA activity scores did not change significantly. Gait analysis demonstrated no significant pre- to final change in hip flexor power, hip abductor impulse,or Gait Deviation Index. Compared to controls, included patients continued to show significantly lower hip flexor power (0.98 vs. 1.45 W/kg, p=0.024) and abductor impulse (0.17 vs. 0.30 Nm/kg-s, p=0.004). Conclusions PAO in CMT patients improved radiographic parameters and significantly improved patient-reported outcomes. Post-operative weakness resolved by 1 year. However, gait parameters did not significantly improve beyond baseline, and compared to healthy controls, gait deviations persisted. These findings suggest that PAO provides structural correction and symptomatic relief in CMT without deterioration of gait. Patients should be counseled that improvements in pain, function and radiographic coverage are expected, whereas gait parameters remain unchanged. Level of Evidence Therapeutic Level IV Key Concepts • Treatment of hip dysplasia in CMT by PAO results in improved radiographic outcomes as well and patient reported outcome scores. • Post-operative weakness following PAO in CMT patients resolves by 1 year follow-up. • PAO in CMT patients does not improve gait parameters at 1 year follow-up, but neither does it result in deterioration of function, i.e., hip symptoms are improved without detriment to walking function.