Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles

Nishiwaki, Toru; Oya, Akihito; Fukuda, Sakae; Nakamura, Satoshi; Nakamura, Masaya; Matsumoto, Morio; Kanaji, Arihiko

doi:10.1177/1120700018772047

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…By binding to plasminogen, TXA prevents the conversion of plasminogen to plasmin, thus preventing fibrinolysis[ 4 ]. The use of TXA reduces blood loss and blood transfusion in major orthopedic surgery, and the safety is also well recognized[ 5 - 8 ]. Previous studies have not confirmed any increased risk of thromboembolism after the use of TXA in various surgeries[ 9 - 11 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis

Xu¹,

Hong²,

Li³

et al. 2021

WJCC

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BACKGROUND Tranexamic acid (TXA) has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades. AIM To evaluate the efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery. METHODS From the electronic resources, PubMed, Cochrane Library, Embase, ISI, and Scopus were used to perform a literature search over the last 10 years between 2010 and 2020. EndNote™ X8 was used for managing the electronic resource. Searches were performed with mesh terms. The data were retracted blindly by two independent reviewers. Random effects were used to deal with potential heterogeneity and I 2 showed heterogeneity. Chi-square ( I 2 ) tests were used to quantify the extent of heterogeneity ( P < 0.01 was considered statistically significant). The efficacy of topical TXA in reducing blood loss and promoting wound healing in bone surgery was compared with intravenous TXA and placebo. RESULTS According to the research design, 1360 potentially important research abstracts and titles were discovered in our electronic searches, and 18 papers remained in agreement with our inclusion criteria. It was found that TXA reduced 277.51 mL of blood loss compared to placebo, and there was no significant difference between topical TXA and IV TXA in reducing blood loss in bone surgery. Our analyses also showed that TXA significantly reduced blood transfusion compared to placebo and there was no significant difference between topical TXA and IV TXA. CONCLUSION The use of both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery, which might be beneficial for wound healing after surgery.

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Section: Introductionmentioning

confidence: 99%

Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis

Xu¹,

Hong²,

Li³

et al. 2021

WJCC

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“…The incidences of complete or incomplete LFCN injury have been reported from 30 to 63% with different surgical approaches [ 1 , 6 ], and a system review shown the rate of complete LFCN injury was 6.14% [ 4 ]. LFCN nerve injury has been reported to be around 30% after a modified S-P approach [ 14 ], about 10.5% after a modified Ollier approach [ 5 ], about 14% after an anterior intrapelvic approach [ 21 ], and about 6.7% [ 24 ] after the operative techniques initially described by Ganz et al [ 7 ]. When the tension induced by traction or compression is applied to a nerve, both the extrinsic and intrinsic vascular supplies would affect the neural ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…The Tönnis classification of hip osteoarthritis [ 16 , 17 ] was used to grade osteoarthritis, and the Hartofilakidis classification system [ 18 , 19 ] was used to assess the dysplastic hip. The indications for acetabulum osteotomy include symptomatic hip dysplasia that persists for more than 6 months after nonsurgical treatment failure, center–edge angle of Wiberg (LCE angle) < 25°, acetabular index (AI) > 10°, Tönnis grade 0–1, Y-type epiphyseal cartilage closure, and younger than 50 years of age [ 14 , 20 , 21 ]. Furthermore, the inclusion criteria included: (I) acetabular reorientation surgery with the use of Bernese PAO, (II) using the modified S-P or Bikini approach with posterolateral assisted incision.…”

Section: Methodsmentioning

confidence: 99%

Treatment of symptomatic hip dysplasia by posterolateral small incision assisted Bernese periacetabular osteotomy

Zhang

Meng

et al. 2022

BMC Surg

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Background For periacetabular osteotomy, traditional approaches usually have a long learning curve. We aimed to evaluate the postoperative results and complications of periacetabular osteotomy under a new double-incision approach. Methods The records of 58 consecutive patients (65 hips) who underwent periacetabular osteotomy using the new approach were retrospectively reviewed and evaluated. There were 52 women and 6 men with a mean age of 28.1 years at the time of surgery. Results The average follow-up period was 35.2 months, during which no patients were converted to total hip arthroplasty. Complications included 6 hips (9.2%) with nerve dysesthesias and 1 hip (1.5%) with delayed wound healing. The mean operative time and intraoperative blood loss were 88.6 min and 402.8 ml, respectively. The mean modified Harris hip score had improved from 72.2 points preoperatively to 91.3 points at the last follow-up. Fifty-five patients (62 hips, 95.4%) were satisfied to their outcomes, and good preoperative functional score was associated with a satisfactory outcome. Furthermore, the average lateral center–edge angle, anterior center–edge angle and acetabular index angle were corrected well after surgery. Conclusion Periacetabular osteotomy using modified Smith-Petersen or Bikini approach with posterolateral assisted small incision can be performed safely and with satisfactory results. In addition, this technique shortens the learning curve, and reduces the operating complexity, especially for beginner.

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“…A critical, intraoperative assessment of the flexion and internal rotation of the hip joint must be performed in every case. Some authors believe less invasive approaches for PAO to be unsuitable to perform a simultaneous arthrotomy for addressing femoral neck pathologies [14,22]. Our described technique for RASS PAO allows for easy arthrotomy, to perform femoral head-neck offset correction via the used Smith-Peterson or Hueter approach, which has been described primarily in 1882 [23].…”

Section: Discussionmentioning

confidence: 99%

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

Löchel

Janz

Perka

et al. 2021

JCM

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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.

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Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles

Abstract: In addition to demonstrating a similarly satisfactory correctional angle, IM-CPO is anticipated to enable early weight-bearing and recovery of walking ability. Thus, IM-CPO is considered a superior surgical technique.

Cited by 6 publications

References 20 publications

Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis

Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis

Treatment of symptomatic hip dysplasia by posterolateral small incision assisted Bernese periacetabular osteotomy

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

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