A dual anteroposterior approach to the Bernese periacetabular osteotomy

Kim, H. T.; Woo, Seung Hun; Lee, J. S.; Cheon, Sang–Jin

doi:10.1302/0301-620x.91b7.21889

Cited by 7 publications

(14 citation statements)

References 26 publications

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“…16 A dual anterior approach for this procedure has recently been recommended. 34 The gluteus muscles were not stripped from the iliac bone, thereby preserving the blood supply to the acetabular fragment and enabling smooth reorientation because the osteotomy surfaces had the same curvatures. The skin incision was approximately 12 cm long.…”

Section: Methodsmentioning

confidence: 99%

Periacetabular osteotomy reduces the dynamic instability of dysplastic hips

Maeyama

Naito

Moriyama

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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We compared the dynamic instability of 25 dysplastic hips in 25 patients using triaxial accelerometry before and one year after periacetabular osteotomy. We also evaluated the hips clinically using the Harris hip score and assessed acetabular orientation by radiography before surgery and after one year. The mean overall magnitude of acceleration was significantly reduced from 2.30 m/s 2 (SD 0.57) before operation to 1.55 m/s 2 (SD 0.31) afterwards. The mean Harris hip score improved from 78.08 (47 to 96) to 95.36 points (88 to 100). The radiographic parameters all showed significant improvements. This study suggests that periacetabular osteotomy provides pain relief, improves acetabular cover and reduces the dynamic instability in patients with dysplastic hips.

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Section: Methodsmentioning

confidence: 99%

Periacetabular osteotomy reduces the dynamic instability of dysplastic hips

Maeyama

Naito

Moriyama

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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“…While realizing this difficulty and in an attempt to improve exposure for the ischial cut, different authors have described variations of the technique using a secondary posterior, medial thigh and suprapubic incisions. 6 - 9 …”

Section: Introductionmentioning

confidence: 99%

“…A posterior Kocher-Langenbeck approach is employed to expose the posterior aspect of the acetabulum and ensure the ischial and retroacetabular cuts are performed precisely, under direct vision and with less use of fluoroscopy. 6 A recent study compared the outcomes of PAO's performed using a single approach and this dual anterior-posterior approach. The authors reported similar operative times and improvement of Wiberg's and Sharp's angles in both groups.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Other surgeons have developed different surgical techniques, such as the direct anterior, the modified Smith–Peterson and the dual anterior–posterior approaches to overcome complications. However, Kim et al compared these techniques and found that there was no difference in patient outcomes, operative time or complication rates in single and double approaches. Therefore, the aim of our study was to provide useful anatomical data measurements to enable the surgeon to perform periacetabular osteotomy more safely, and to provide data on the optimal osteotomy distances based on 3D CT scans.…”

Section: Discussionmentioning

confidence: 99%

Virtual Periacetabular Osteotomy and Anatomical Measurements

Xú

Dong

Król

et al. 2019

Orthopaedic Surgery

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Objective To report on a CT scan virtual periacetabular osteotomy (PAO) process to evaluate the potential risk of different PAO cutting planes. Methods A total of 123 patients (64 men and 59 women) underwent virtual PAO. We defined two retroacetabular cutting (RC) planes: the RC plane and the RC+ plane (10 mm posteriorly as compared to the RC plane). Subsequently, we measured the anatomical minimum distance between the acetabulum and the sciatic notch, the minimum distance between the acetabulum and the retroacetabular cutting plane (osteotomy of the posterior column), and the osteotomy length in the cranio‐caudal direction. Results The mean (standard deviation [SD]) minimum distance between the acetabulum and the sciatic notch was 25.82 ± 3.52 mm (95% confidence intervals [CI], 25.36–26.25 mm). In men, the mean (SD) minimum distance between the acetabulum and sciatic notch (27.18 ± 3.47 mm; 95% CI, 26.56–27.78 mm) was significantly (3 mm) larger than in women (24.34 ± 2.92 mm; 95% CI, 23.82–24.89 mm; P < 0.001). The mean (SD) minimum distance between the acetabulum and the retroacetabular plane was significantly larger for the RC+ plane (6.97 ± 0.91 mm) than for the RC plane (P < 0.001). In men, this distance (10.23 ± 3.84 mm) was significantly (2.3 mm) larger than in women (7.94 ± 3.45 mm; P < 0.001). The mean (SD) osteotomy length was significantly larger for the RC+ plane (61.78 ± 6.75 mm) than for the RC plane (68.48 ± 6.65) mm; P < 0.001). All three evaluated parameters had significantly shorter lengths in women than in men. Conclusion The safety space for PAO in women was narrower than in men. By shifting the RC plane 10 mm into the posterior direction, the RC+ plane provides a safer cutting distance and shorter osteotomy line in the PAO than the RC plan, which is important to avoid intraarticular penetration.

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A dual anteroposterior approach to the Bernese periacetabular osteotomy

Cited by 7 publications

References 26 publications

Periacetabular osteotomy reduces the dynamic instability of dysplastic hips

Periacetabular osteotomy reduces the dynamic instability of dysplastic hips

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

Virtual Periacetabular Osteotomy and Anatomical Measurements

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