A Comparison of Different Surgical Approaches for the Periacetabular Osteotomy

Hussell, J.G.; Mast, Jeffrey W.; Mayo, Keith A.; Howie, Donald W.; Ganz, Reinhold

doi:10.1097/00003086-199906000-00009

Cited by 89 publications

(89 citation statements)

References 8 publications

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“…The PAO is a complex and extensive surgical procedure associated with a technical learning curve. Different types of surgical approaches influence PAO morbidity [8,23,27]. A transartorial less invasive technique has been reported as an alternative to the classic approach [24].…”

Section: Discussionmentioning

confidence: 99%

“…Since the original description, there have been several reports describing different surgical approaches to perform a PAO. These include the ilioinguinal approach [8,17,23,27], a direct anterior approach without abductor dissection [13], and a ''minimally invasive transsartorial approach'' [24]. However, there are few studies comparing clinical and functional outcomes between these different approaches [8,23].…”

Section: Introductionmentioning

confidence: 99%

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The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches. Questions/purposes The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach. Methods A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13-44 months). Results Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21-29; p \ 0.0001) and control groups (mean improvement, 21; 95% CI, 17-25; p \ 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, À1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center-edge angle (p = 0.4463), anterior center-edge angle (p = 0.0936), and Tönnis angle (p = 0.7953) improvement when compared with the classic approach. Conclusions The rectus-preserving approach for PAO is as safe and effective as the classic approach to achieve radiographic correction and HHS improvement at minimum 1 year. Additional investigation is needed to determine whether the rectus-preserving approach allows for improvement in functional recovery including hip flexion strength.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The standard Bernese PAO includes takedown of the direct and indirect heads of the rectus tendon and allows an anterior capsulotomy to address chondrolabral lesions and femoral head-neck offset issues [9,18]. Although this approach facilitates surgical objectives, early recovery is often limited by pain and symptom-based activity modulation as well as surgeon-based restrictions.…”

Section: Introductionmentioning

confidence: 99%

Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

Peters

Erickson

Anderson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The early recovery period after periacetabular osteotomy (PAO) can be limited by pain and activity restrictions. Modifications of the Bernese PAO, including sparing the rectus tendon and discontinuing routine arthrotomy, may accelerate early postoperative recovery compared with the standard approach. Questions/purposes Does a modified approach for PAO (1) lead to improved pain control immediately after surgery; (2) lead to improved ambulation during the hospital stay; (3) lead to shorter stays, less blood loss, and shorter surgical times; and (4) compromise acetabular correction? Methods We retrospectively reviewed all 75 patients who underwent PAO for developmental dysplasia of the hip between August 2009 and May 2013. The control group included 44 consecutive patients who underwent a standard Bernese PAO with rectus takedown (RT). The study group consisted of 31 consecutive patients who underwent PAO using a modified rectus-sparing (RS) approach without routine arthrotomy. The groups were similar in age, body mass index, and American Society of Anesthesiologists score, but the RT group was comprised of a greater percentage of men than the RS group. Outcome variables were collected from patient charts and included inpatient pain, inpatient ambulation as well as length of stay, estimated blood loss, surgical time, and postoperative radiographic measurements. Cohen's f 2 was used to calculate the effect size in the regression analysis and effects were considered small for values \ 0.15, moderate for 0.15 to 0.34, and large for values [ 0.35. Results Patients who underwent PAO with a RS approach had less overall pain (RT median 4 versus RS median 2); however, the difference may not have been perceptible to the typical patient (p = 0.001, f 2 = 0.059). Patients treated with the RS approach ambulated similar distances during the hospital stay with a median 11 feet (interquartile range [IQR], 0-72.5) for the RT group and a median 30 feet (IQR, 0-100) for the RS group (p = 0.215, f 2 = 0.095).

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“…Since the original description of the operation, several minor modifications of the original technique have evolved [11]. The musculature on the outer wall of the pelvis is now routinely preserved leaving the tensor fascia lata and gluteus medius intact [12].…”

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confidence: 99%

The Bernese periacetabular osteotomy for treatment of adult hip dysplasia

McKinley

2010

Skeletal Radiol

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A Comparison of Different Surgical Approaches for the Periacetabular Osteotomy

Cited by 89 publications

References 8 publications

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

The Bernese periacetabular osteotomy for treatment of adult hip dysplasia

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