Complications and outcome after periacetabular osteotomy - influence of surgical approach

Abstract

Background: Bernese periacetabular osteotomy (PAO) was introduced by Ganz as a novel surgical technique for hip dysplasia with a congruent hip to reorient the acetabulum in skeletally mature patients. The PAO through a modified Smith-Petersen (Iliofemoral) approach, has been subject to many modifications in order to avoid complications and to minimise risks for failure. Aim: The aim of this review was to report on the complication rates, functional and radiological outcomes in relation to surgical approaches. Methods: A search of NICE healthcare database advanced search, was conducted from the year of inception to May 2018. We included studies that reported complications of PAO. Data extracted from case series was analysed to detect the incidence of complications, relation to surgical approach and temporal trend of complications. Results: 40 studies including 4070 hips with a mean age of 29 years and a mean follow-up of 52.8 month, were analysed. Outcome measures demonstrated good to excellent outcome in 82%. Higher rates of LFCN and sciatic nerve injuries were found to be associated with the ilioinguinal and the 2-incision approach. Minimally invasive (MIS) modified Smith-Petersen (MSP), minimally invasive trans-sartorial and trans-trochanteric approaches were not reported to be associated with any major wound complications. Radiological correction achieved with a mean improvement in acetabular inclination of 17.90 (range 4.5–40), anterior centre-edge correction 25.40 (range 10–51), lateral centre-edge correction 23.30 (range 15–44.6) and medial translation of 6 mm (range 3.2–10). Conclusions: The complication rates seem to be lower in this current review (7%) as compared to the previous review performed by Clohisy et al. (6–37%). The MIS trans-sartorial/MIS MSP and intertrochanteric approaches are associated with an even reduced complications rates. This review enables favouring the minimally invasive approaches with regard to reducing nerve injury and wound complications.

Comparison of the Modified Smith-Petersen (S-P) and Ilioinguinal (I-I) Approaches for Periacetabular Osteotomy in Adult Developmental Dysplasia of the Hip: A Retrospective study

“…The ilioinguinal approach is performed on all osteotomies and under direct vision to obtain the best of the deep internal pelvic visibility, and the remained abductor muscles. However, the ilioinguinal approach has a higher risk of serious vascular damage, and does not allow an exploration of the hip joint [21][22][23].…”

Periacetabular Pelvic Osteotomy in Treatment of Patients with Developmental Dysplasia of the Hip

“…Многие исследователи вносят модификации в ход оригинальной хирургической техники ПАО, предложенной R. Ganz и тем самым получают более высокие функциональные результаты лечения пациентов или снижают количество осложнений. Например, авторы используют мини-инвазивные доступы к ТБС [17,18,19], илиоингвинальный доступ [20], модифицированную пластинчатую остео томию подвздошной кости, позволяющую избежать использования фиксирующих винтов [21] и некоторые другие модификации. В настоящее время мы предпочитаем классическую методику ПАО, видоизменив лишь разрез.…”

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

“…The conventional surgical technique requires considerable exposure and is in the immediate vicinity of multiple neurovascular structures. Even in the hands of experienced surgeons, significant complications have been reported in the literature [ 3 , 6 , 7 , 8 ].…”

“…Since the initial description of the PAO technique, different approaches have been reported [ 2 ]. The Smith-Petersen approach is the most commonly used approach [ 6 , 9 , 10 ]. Less invasive techniques, such as rectus tendon sparing and transsartorial approaches are reported to minimize surgical trauma, reduce surgical time, blood loss, and length of hospital stay (LOHS) [ 11 , 12 , 13 , 14 ].…”