Complications Associated with the Periacetabular Osteotomy

Zaltz, Ira; Baca, Geneva; Kim, Young Jo; Schoenecker, Perry L.; Trousdale, Robert T.; Sierra, Rafael J.; Sucato, Daniel J.; Sink, E.L.; Beaulé, Paul E.; Millis, Michael B.; Podeszwa, David A.; Clohisy, John C.

doi:10.2106/jbjs.n.00113

Cited by 130 publications

(105 citation statements)

References 29 publications

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“…Furthermore, no significant complications were encountered after the procedure. In a recent multicenter study, the rate for significant complications was reported to be 6%, emphasizing the importance of expertise and experience required by the surgical team [29].…”

Section: Discussionmentioning

confidence: 99%

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Grammatopoulos

Wales

Kothari

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described. Questions/purposes The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction. Methods The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle\25°and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study's mean followup was 8 years (range, 2-18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0-96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software. Results The 10-year survival rate was 93% (95% confidence interval [CI], 82%-100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0-54 Conclusions This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Grammatopoulos

Wales

Kothari

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…From January 1, 2008, to December 31, 2010, 11 surgeons at 8 North American medical centers prospectively enrolled 478 consecutive hips (445 patients) treated with PAO (the PAO-1 cohort). All participating surgeons have experience in PAO surgery 19 . All patients were offered study participation.…”

Section: Patient Selectionmentioning

confidence: 99%

“…We previously reported on complications associated with PAO surgery 19 . Major complications were defined as grade III (requiring intervention) or IV (life-threatening or with the potential for permanent disability) according to the Dindo-Clavien grading scheme 32,33 as modified and validated by our group 34,35 .…”

Section: Surgical Treatmentmentioning

confidence: 99%

Patient-Reported Outcomes of Periacetabular Osteotomy from the Prospective ANCHOR Cohort Study

Clohisy

Ackerman

Baca

et al. 2017

The Journal of Bone and Joint Surgery

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171

138

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“…Nevertheless, contemporary studies have described PAO as a safe procedure with a low incidence of major complications when performed by experienced surgeons [25,28]. A recent study reported a 6% risk of major complications in 205 patients undergoing PAO by a group of 10 surgeons with an average of 9 years (range, 1-37 years) of experience [28].…”

Section: Introductionmentioning

confidence: 99%

“…A recent study reported a 6% risk of major complications in 205 patients undergoing PAO by a group of 10 surgeons with an average of 9 years (range, 1-37 years) of experience [28]. However, there is little evidence about length and type of training necessary to achieve this level of expertise.…”

Section: Introductionmentioning

confidence: 99%

Does Surgeon Experience Impact the Risk of Complications After Bernese Periacetabular Osteotomy?

Novais

Carry

Kestel

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Bernese periacetabular osteotomy (PAO) is a technically challenging procedure with potential risk for major complications and a previously reported steep learning curve. However, the impact of contemporary hip preservation fellowships on the learning curve of PAO has not been established. Questions/purposes (1) What was the frequency of major complications during the PAO learning curve of two surgeons who recently graduated from hip preservation fellowships? (2) Is increasing level of experience associated with the risk of a complication and with operative time, a possible surrogate measure of surgical performance? Methods We retrospectively studied 81 PAOs performed by one of two surgeons who recently graduated from a hip preservation fellowship during their first 4 years of practice in two institutions. One of the surgeons participated as a fellow in 78 PAOs with an increasing level of responsibility during the course of 1 full year. The other surgeon performed 41 PAOs as a fellow during 6 months, also with an increasing level of responsibility during that time. There were 68 (84%) female and 13 (16%) male patients (mean age, 18 years; range, 10-36 years). The frequency of complications was recorded early and at 1 year after surgery and graded according to a validated classification system describing five grades of complications. Complications that required surgical intervention (Grade III) and life-threatening complications (Grade IV) were considered major complications. Persistent pain after surgery, although considered a failure of PAO, was not considered a surgical complication as a result of the multifactorial etiology of pain after hip-preserving surgery. However, early reoperation and revision surgery were counted as complications. To evaluate the association between increasing level of experience and the occurrence of complications, we divided each surgeon's experience into his first 20 procedures (initial interval) and his second 20 (experienced interval) to test whether the incidence of complications or operative time was different between the two intervals. Because the association between experience and the likelihood of a complication was estimated to be consistent between the two surgeons, the analysis was performed with data pooled from the two surgeons. To test whether there was a difference in the likelihood of a complication in the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical princ...

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Complications Associated with the Periacetabular Osteotomy

Cited by 130 publications

References 29 publications

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Patient-Reported Outcomes of Periacetabular Osteotomy from the Prospective ANCHOR Cohort Study

Does Surgeon Experience Impact the Risk of Complications After Bernese Periacetabular Osteotomy?

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