Diagnosis and Management of Developmental Dysplasia of the Hip from Triradiate Closure Through Young Adulthood

Siebenrock, Klaus A.; Steppacher, Simon D.; Albers, Christoph E.; Haefeli, Pascal C; Tannast, Moritz

doi:10.2106/00004623-201304170-00012

Cited by 14 publications

(15 citation statements)

References 48 publications

(51 reference statements)

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“…Such results were seen in the hands of an experienced pelvic osteotomy surgeon, having performed [ 500 cases. The difficulties associated with achieving the desired orientation of the acetabulum have been demonstrated in both arthroplasty and joint preservation surgery [7,8,23]. Given the significant contribution of the radiographic correction to the chances of success after Bernese PAO, refined methods of reducing the learning curve and consistently obtaining optimal orientation are necessary.…”

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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“…We are aware of only two studies reporting a PAO technique without complete transection of the rectus femoris tendon attachment. Siebenrock et al [17] reported their current PAO technique using an ilioinguinal approach and preserving the rectus femoris tendon attachment. However, their study was a review article that did not report any clinical, functional, or radiographic results nor did they compare the technique with the classic approach.…”

Section: Discussionmentioning

confidence: 99%

“…Since the original description, there have been several reports describing different surgical approaches to perform a PAO. These include the ilioinguinal approach [8,17,23,27], a direct anterior approach without abductor dissection [13], and a ''minimally invasive transsartorial approach'' [24]. However, there are few studies comparing clinical and functional outcomes between these different approaches [8,23].…”

Section: Introductionmentioning

confidence: 99%

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches. Questions/purposes The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach. Methods A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13-44 months). Results Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21-29; p \ 0.0001) and control groups (mean improvement, 21; 95% CI, 17-25; p \ 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, À1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center-edge angle (p = 0.4463), anterior center-edge angle (p = 0.0936), and Tönnis angle (p = 0.7953) improvement when compared with the classic approach. Conclusions The rectus-preserving approach for PAO is as safe and effective as the classic approach to achieve radiographic correction and HHS improvement at minimum 1 year. Additional investigation is needed to determine whether the rectus-preserving approach allows for improvement in functional recovery including hip flexion strength.

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“…The originally used modified Smith-Petersen incision often shows unsatisfactory scar formation in the distal part of the incision and there is a risk of injury to the lateral femoral cutaneous nerve. A shortened ilioinguinal incision [54] partly overcome these complications. The incision starts at the anterior third of the iliac wing and extends slightly medial to the ASIS.…”

Section: Approachmentioning

confidence: 99%

Periacetabular osteotomy: a review of swiss experience

Büchler

Beck

2014

Curr Rev Musculoskelet Med

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Symptomatic dysplasia of the hip and acetabular retroversion are possible causes of osteoarthritis in the young adult. Surgical management with reorientation of the acetabulum allows causal therapy of the deformity and preservation of the native hip joint. The Ganz' periacetabular osteotomy permits a free 3-dimensional reorientation of the acetabulum and respects the blood supply of the acetabular fragment. The posterior column remains intact with a stable fixation of the acetabular fragment and a preserved shape of the true pelvis. There is a significant learning curve with severe complications in up to 30 % of cases. Good results can be expected in the long-term follow-up if performed with correct indication at young age in hips with preserved joint cartilage and proper reorientation of the acetabular fragment. Overall survivorship is superior to the natural course of hip dysplasia with a preserved hip joint in 61 % after 20 years.

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Diagnosis and Management of Developmental Dysplasia of the Hip from Triradiate Closure Through Young Adulthood

Cited by 14 publications

References 48 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?

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Periacetabular osteotomy: a review of swiss experience

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