Cadaveric Study on the Learning Curve of the Two-Approach Ganz Periacetabular Osteotomy

Abstract

Objective: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods: We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results: Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions: We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. Evidence Level: IV, Cadaveric Study.

Virtual Periacetabular Osteotomy and Anatomical Measurements

“…A shorter length of the osteotomy plane can reduce the risk of intra‐articular penetration as well as the difficulty of the operation. Similar results by Ferro et al also led to the recommendation. That retroacetabular cutting should keep a safe distance of 1 cm from the margin of the posterior column and should be parallel to it; complications were observed in 7 specimens (46%).…”

“…There were four steps or cutting planes for each virtual PAO. To attain standardized results, we defined all four cutting planes as precisely as possible based on the methods described in the published literature.…”

“…Davey et al also found that major complication rates decreased from 17% to 2.9% when the first 35 cases were compared with the second 35 cases of PAO performed by one surgeon. Ferro et al suggested training in this technique in multiple cadavers before performing it in live patients.…”

Three-Dimensional Digital Surgical Planning and Rapid Prototyped Surgical Guides in Bernese Periacetabular Osteotomy

“…In selected cases, disease progression to osteoarthritis was avoided, with good clinical outcomes with up to 30 years of follow-up [2]. Nonetheless, it is a complex and technically demanding surgery, with a steep learning curve [4,5]. Among the reported PAO surgery complications, intra-articular fractures, posterior column fractures, and damage to vascular structures and nerves are the more severe examples and are directly related to the surgical technique [6,7].…”