A Modification of Periacetabular Osteotomy Using a Two-Incision Approach

Abstract

Abstract:In residual hip dysplasia periacetabular osteotomy (PAO) can improve insufficient coverage of the femoral head. It requires a broad dissection of the pelvic bones and detachment of muscle insertions, however. We have developed a modification of the Bernese periacetabular osteotomy with reduced soft tissue exposure. It uses two small skin incisions and offers therefore the perspective of nicer scars but also increases the risk of technical complications due to impaired vision. To be able to draft these risks, the clinical and radiographic results of 23 patients with PAO through the modified Smith-Petersen approach of Ganz (group A) and 24 patients with our two-incision modification (group B) have been reviewed retrospectively with an average follow-up of 19 (group A) and 12 (group B) months postoperatively.Functional improvement (Harris Hip Score) and center-edge-angle normalization did not differ significantly in both groups. Scars of patients in group B were significantly shorter. However, the overall patient satisfaction (as measured with a visual analogous scale) was the same in both groups. 4 patients in group A and one patient in group B developed superficial or deep wound infections.In conclusion, the experience with our cohort study showed that approach-related morbidity can be reduced without increasing the risk for the individual patient. This observation clearly holds a promise for further minimal invasive approaches as well as for further morbidity reduction of PAO.Level of Evidence: Retrospective comparative study (Level III).

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

“…This was similar the finding of Bernstein et al [2] and Troelsen et al [23] who both reported similar acetabular correction normalization between groups with standard versus minimally invasive approaches.…”

“…Recent studies have described alternative approaches to the Bernese PAO in the hopes of decreasing complications, surgical time, surgical trauma, estimated blood loss, and length of stay (LOS) while maintaining the ability to reorient the acetabulum [2,14,19,23]. Based on these reports, we began modifying the standard Bernese PAO with a rectus femoris-sparing surgical approach without arthrotomy for PAO in 2012.…”

“…Alternative approaches have been developed with the goal of being less invasive while maintaining the ability to reorient the acetabulum and preserve hip flexion strength [2,14,19,20,23]. We sought to determine whether a modified RS approach would lead to comparable inpatient pain control and ambulation with shorter LOS, less EBL, shorter surgical times, and equivalent success of acetabular reorientation.…”

“…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.…”

Less Invasive Rotational Acetabular Osteotomy for Hip Dysplasia

“…Although minimally invasive surgery is commonly used in THAs [8, 19, 22], there are only a few reports regarding minimally invasive surgery for acetabular reorientation osteotomy [2, 20, 28, 29]. There are several reports regarding acetabular redirectional osteotomies for hip dysplasia, such as the triple osteotomy [24], dial osteotomy [14], double osteotomy [25], spherical osteotomy [33], rotational osteotomy [18, 26, 27], and periacetabular osteotomy [7], which are recognized standard surgical procedures for early stages of degenerative osteoarthritis.…”