Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

Abstract

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 ± 0.57 m/sec2 preoperatively to 1.55 ± 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20° could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.

Prevalence and characteristics of cam-type femoroacetabular deformity in 100 hips with symptomatic acetabular dysplasia: a case control study

“…This combined procedure provided effective correction of associated femoral head-neck deformities and produced similar early functional outcomes to isolated periacetabular osteotomy. We have also been performing CPO in conjunction with osteochondroplasty for the treatment of AD associated with FAI since 2006 [ 38 ] (Figures 2 and 3 ). Although it usually takes about 15 min longer than isolated periacetabular osteotomy, the combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increase in the complication rate.…”

Posterior Pelvic Tilt From Supine to Standing in Patients With Symptomatic Developmental Dysplasia of the Hip

“…In patients with developmental dysplasia of the hip (DDH), insufficient femoral head coverage by the acetabulum leads to the progression of osteoarthritis (OA) . To improve femoral head coverage and prevent the progression of OA, various kinds of re‐directional periacetabular osteotomies, including rotational acetabular osteotomy (RAO), Bernese periacetabular osteotomy, and curved periacetabular osteotomy (CPO), are performed. Often, the femoral head coverage in DDH patients is measured from radiographs in a supine or standing position, and the measurements are used for diagnosis.…”

Sciatic Nerve Palsy following Curved Periacetabular Osteotomy

“…CPO was developed in 1995 and performed for symptomatic acetabular dysplasia treatment in young adults [1]. Previous reports have shown satisfying clinical outcomes due to reoriented acetabulum, resulting in the improvement of the femoral head coverage and abductor muscle strength [7,11].…”

“…The rate of severe complications following CPO was reported to be very low and related to traditional periacetabular osteotomy [7]. Leunig et al reported a case of sciatic nerve palsy following periacetabular osteotomy [12].…”

“…However, various severe complications such as nerve palsy, necrosis of the femoral head, and delayed union or absence of union have been reported in a few cases [4][5][6]. In contrast, severe complications are rare after CPO [7]. To our knowledge, there is no published report of postoperative sciatic nerve palsy.…”