A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip

Abstract

Background: periacetabular osteotomy (PAO) is known as the gold standard surgical treatment in young adults with symptomatic hip dysplasia. With the aim of reducing soft tissue trauma, we developed a new rectus and sartorius sparing (RASS) approach. We hypothesized that this new PAO technique was equal regarding acetabular reorientation, complication rate, and short-term clinical outcome parameters, compared to our conventional, rectus sparing (RS) approach. Patients and Methods: we retrospectively assessed all PAO procedures performed by a single surgeon between 2016 and 2019 (n = 239 hips in 217 patients). The cases in which the new RASS technique were used (n = 48) were compared to the RS cases for acetabular orientation parameters, surgical time, perioperative reduction of hemoglobin level, and length of hospital stay (LOHS). Inclusion criteria were a lateral center-edge angle (LCEA) <25° and osteoarthritis Tönnis grade ≤1. Patients with acetabular retroversion or additional femoral osteotomy were excluded. Results: the mean patient age at the time of surgery was 29 years (14 to 50, SD ± 8.5). Females accounted for 79.5% in this series. The mean preoperative LCEA were 16° (7 to 24°, SD ± 4.4) and 15° (0 to 23°, SD ± 6) in the RASS and the RS group, respectively (p = 0.96). The mean preoperative acetabular index (AI) angles were 14° (2 to 25°, SD ± 4) and 14° (7 to 29°, SD ± 4.3), respectively (p = 0.67). The mean postoperative LCEA were significantly improved to 31° (25 to 37°, SD ± 3.5, p < 0.001) and 30.2° (20 to 38°, SD ± 4, p < 0.001), respectively. The mean postoperative AI angles improved to 2.8° (−3 to 13°, SD ± 3.3, p < 0.001) and 3° (−2 to 15°, SD ± 3.3, p < 0.001), respectively. There were no significant differences between the RASS and the RS group for surgical time, perioperative reduction in hemoglobin level, and LOHS. No blood transfusions were necessary perioperatively in either group. No major perioperative complication occurred in either group. We observed one surgical site infection (SSI) requiring superficial debridement in the RS group. Conclusion: the RASS approach for PAO showed to be a safe procedure with equivalent acetabular reorientation and equivalent clinical outcome parameters compared to the RS approach. Additionally, patients have fewer postoperative restrictions in mobilization with the RASS approach.

Case Report: Intraarticular Iliopsoas Tendon causes Groin Pain Following Periacetabular Osteotomy

“…The standard approach used for PAO in our clinic aims not to open the joint capsule ( 10 ); however, the capsule can either be opened accidently when preparing the osteotomy of the ilium by bluntly releasing structures off the capsule with a Hohman's retractor or intentionally for concomitant treatment of intraarticular pathologies via capsulotomy. The latter mentioned is similar to the DAA for THA.…”

Novel Utilization of Anterior Intrapelvic (Stoppa) Approach for Periacetabular Ganz Osteotomy

“…Later modifications of the approach focused on less invasiveness to include omittance of the ASIS osteotomy, smaller incisions, and the minimally invasive subsartorial or trans-sartorial approach. These alterations from the first described Smith-Peterson approach reduced surgical trauma, operative time, blood loss, and hospitalization [16][17][18][19][20][21][22] . Considerations for choosing the surgical approach for the osteotomy should revolve around safety, efficacy, intraoperative visualization, and patient satisfaction.…”

Bone marrow from periacetabular osteotomies as a novel source for human mesenchymal stromal cells

“…During the procedure, three osteotomies are performed to enable reorientation of the acetabulum and to thereby achieve an improved coverage of the femoral head [ 26 ]. Bone marrow-containing bone wedges are sometimes resected from the anterior Os ilium or superior Os pubis and discarded as surgical waste in the course of PAO [ 27 ]. So far, bone wedges from PAO patients have not been recognized as a potential cell source from young patients.…”