Early Results of the Bernese Periacetabular Osteotomy: The Learning Curve at an Academic Medical Center

Peters, Christopher L.; Erickson, Jill; Hines, Jerod

doi:10.2106/jbjs.e.00515

Cited by 140 publications

(165 citation statements)

References 34 publications

(17 reference statements)

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“…The standard RT approach was performed following previously described techniques [5,8,16]. After performing an osteotomy of the anterosuperior iliac spine (ASIS) with the sartorius and abdominal muscles attached, it is retracted medially and then the approach is extended distally between the tensor fascia latae and sartorius.…”

Section: Description Of Experiment Treatment or Surgerymentioning

confidence: 99%

“…Radiographically, the use of the centeredge angle with at least one other measurement, including the acetabular index, has been recommended to accurately assess dysplasia in young adults [15]. Thus, pre-and postoperative radiographs were measured as previously described [1,6,16] for the acetabular index, lateral centeredge angle (LCEA), anterior center-edge angle (ACEA), and Tönnis Grade of Osteoarthritis by an experienced clinician other than the operating surgeon (JAE). The reproducibility of these measures has been demonstrated as adequate to excellent in the literature [1,3,4,10,12,21].…”

Section: Variables Outcome Measures Data Sources and Biasmentioning

confidence: 99%

“…Although the study and control groups differed in some respects (sex, slight but probably not clinically significant differences in the magnitude of radiographic dysplasia), we attempted to minimize selection bias by performing the different surgical approaches in consecutive series of patients. The ''learning curve'' for adopting the RS approach was quite low and the modification of the original approach was easily incorporated into the surgical workflow and required no modification of the classic osteotomies for a standard PAO [16]. The fact that preservation of the rectus tendon origin was intuitive and did not complicate osteotomy, mobilization or reorientation of the acetabular fragment made it relatively easy to perform on a consecutive series of patients without the need for selection of ''simpler'' cases.…”

Section: Limitationsmentioning

confidence: 99%

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Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

Peters

Erickson

Anderson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The early recovery period after periacetabular osteotomy (PAO) can be limited by pain and activity restrictions. Modifications of the Bernese PAO, including sparing the rectus tendon and discontinuing routine arthrotomy, may accelerate early postoperative recovery compared with the standard approach. Questions/purposes Does a modified approach for PAO (1) lead to improved pain control immediately after surgery; (2) lead to improved ambulation during the hospital stay; (3) lead to shorter stays, less blood loss, and shorter surgical times; and (4) compromise acetabular correction? Methods We retrospectively reviewed all 75 patients who underwent PAO for developmental dysplasia of the hip between August 2009 and May 2013. The control group included 44 consecutive patients who underwent a standard Bernese PAO with rectus takedown (RT). The study group consisted of 31 consecutive patients who underwent PAO using a modified rectus-sparing (RS) approach without routine arthrotomy. The groups were similar in age, body mass index, and American Society of Anesthesiologists score, but the RT group was comprised of a greater percentage of men than the RS group. Outcome variables were collected from patient charts and included inpatient pain, inpatient ambulation as well as length of stay, estimated blood loss, surgical time, and postoperative radiographic measurements. Cohen's f 2 was used to calculate the effect size in the regression analysis and effects were considered small for values \ 0.15, moderate for 0.15 to 0.34, and large for values [ 0.35. Results Patients who underwent PAO with a RS approach had less overall pain (RT median 4 versus RS median 2); however, the difference may not have been perceptible to the typical patient (p = 0.001, f 2 = 0.059). Patients treated with the RS approach ambulated similar distances during the hospital stay with a median 11 feet (interquartile range [IQR], 0-72.5) for the RT group and a median 30 feet (IQR, 0-100) for the RS group (p = 0.215, f 2 = 0.095).

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Section: Description Of Experiment Treatment or Surgerymentioning

confidence: 99%

Section: Variables Outcome Measures Data Sources and Biasmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

Peters

Erickson

Anderson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Peters et al [45] concluded that recognition of the true preoperative acetabular version and reorientation of the acetabulum into an appropriately anteverted position have become important factors in surgical decisionmaking. Steppacher et al [52] found a nonspherical shape of the femoral head and acetabulum in dysplastic hips could potentially induce a painful FAI or influence the result of a reorientation procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The preoperative maximum lateral center-edge angle was 10°to 30°in PAO [4,6,7,23,27,45,47,50,56,57] and 10°to 20°in RAO [10, 15, 16, 20, 21, 26, 35, 39-43, 53, 54, 61, 63-65].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Patient Selection Criteria for Periacetabular Osteotomy or Rotational Acetabular Osteotomy

Yasunaga

Yamasaki

Ochi

2012

Clinical Orthopaedics &Amp; Related Research

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Background Hip dysplasia is the most common cause of secondary osteoarthritis (OA). Periacetabular osteotomy (PAO) or rotational acetabular osteotomy (RAO) has been used as a joint-preserving procedure. However, the patient selection criteria are not clearly defined. Questions/purposes Based on a systematic review, we identified reported patient selection criteria for PAO or RAO. Methods We performed a systematic review of RAO and 18 studies met our inclusion criteria. For the PAO, the systemic review performed by Clohisy et al. was used. Where Are We Now? For patients with symptomatic hip dysplasia, lateral center-edge angle less than 10°to 30°, radiographic pre-or early OA, mean age at the time of surgery of 18 to 45 years, and improvement in joint congruency on AP radiograph with hip abduction, radiographic deformity correction consistently improved hip function in all studies. Radiographic OA progression was noted in 5% to 33% at 3.2 to 20 years postoperatively. Clinical score and prevention of radiographic OA progression of patients 50 years or older or with advanced stage were worse in younger patients or those with early stage. Where Do We Need to Go? The key challenges are (1) preoperative evaluation of articular cartilage; (2) indication for older patients; (3) prevention of secondary femoroacetabular impingement; and (4) intraarticular treatment combined with PAO or RAO. How Do We Get There? Future prospective, longitudinal cohort studies need to determine optimal patient selection criteria, risk factors for clinical failure, optimal deformity correction parameters, and the role of adjunctive surgical procedures.

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Introduction to Static and Dynamic Overload of Hip Pathology

Knesek

Bedi

Skendzel

2014

Hip Arthroscopy and Hip Joint Preservation Surgery

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Early Results of the Bernese Periacetabular Osteotomy: The Learning Curve at an Academic Medical Center

Abstract: Therapeutic Level IV.

Cited by 140 publications

References 34 publications

Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

Patient Selection Criteria for Periacetabular Osteotomy or Rotational Acetabular Osteotomy

Introduction to Static and Dynamic Overload of Hip Pathology

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