Lessons learned after more than 250 periacetabular osteotomies

Trousdale, Robert T.; Cabanela, Miguel E.

doi:10.1080/00016470310013824

Cited by 105 publications

(62 citation statements)

References 13 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The Bernese periacetabular osteotomy (PAO) was first described by Ganz et al [8] in the 1980s and has become the preferred method of surgical treatment of developmental dysplasia of the hip (DDH) in adult patients in North America and Europe [8,11,13,22,24,25]. The standard Bernese PAO includes takedown of the direct and indirect heads of the rectus tendon and allows an anterior capsulotomy to address chondrolabral lesions and femoral head-neck offset issues [9,18].…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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).

show abstract

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Achieving optimal placement of the acetabular fragment is one of the biggest challenges of an acetabular reorientation [40,50,54]. Malpositioning leads to insufficient femoral head coverage, restricted ROM, femoroacetabular impingement, and progressive osteoarthritis leading to hip arthroplasty [9,16,20,28,53].…”

Section: Introductionmentioning

confidence: 99%

“…Malpositioning leads to insufficient femoral head coverage, restricted ROM, femoroacetabular impingement, and progressive osteoarthritis leading to hip arthroplasty [9,16,20,28,53]. The position for optimal correction is specific for each patient, and fairly narrowly defined [54]. Tsumura et al studied three-dimensional joint pressure redistribution in dysplastic hips, and noted that the lowest peak pressures were achieved by transposing the acetabular fragment to within 5°of the optimal transposition point [55].…”

Section: Introductionmentioning

confidence: 99%

Pelvic Positioning Creates Error in CT Acetabular Measurements

Bosse¹,

Lee

Henderson

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background CT allows for accurate measurement of acetabular orientation and shape, but malpositioning of the pelvis may lead to measurement variance. Purpose We therefore sought to determine: (1) whether acetabular anteversion measurements using the femoral head centers differed from those using the posterior ischia, and (2) the extent to which changing obliquity, rotation, and tilt of a pelvis in a CT scanner affected the measurement of acetabular variables. Methods A radiopaque human pelvis model with articulated hips was suspended from a plastic sheet as part of an adjustable frame. Changes in the transverse and sagittal planes created rotation and tilt, while rotating the frame in the coronal plane created obliquity. CT scans were obtained, varying the combinations of obliquity, rotation, and tilt by intervals of 5°, up to 20°. Acetabular anteversion (AA), anterior acetabular sector angle (AASA), posterior acetabular sector angle (PASA), and horizontal acetabular sector angle (HASA) were measured. Results The two methods for measuring AA yielded values differing by 1°to 4°but correlated (r = 0.981) across the spectrum of pelvis positioning. Pelvic obliquity and tilt were linearly associated with changes in the measurements. For each 1°-increase in pelvic obliquity, AA changed À0.4°, and AASA, PASA, and HASA changed 1.93°, 0.99°, and 2.80°, respectively. For each 1°-increase in pelvic tilt, AA changed 0.8°, and AASA, PASA, and HASA changed À1.07°, 0.52°, and À0.51°, respectively. Rotation had no affect on the variables. Conclusions Small changes in pelvic obliquity and tilt were associated with variances in acetabular measurements. The measured changes were directly proportional to the changes in obliquity and tilt, and were additive. Pelvic rotation created no changes in measurement. Clinical Relevance Incorrect interpretation of acetabular anteversion and coverage may lead to unsatisfactory acetabular fragment positioning during reorientational surgery. Although intraoperative positioning of an acetabular fragment may not be as precise as the tools for preoperative planning, it is important for a surgeon to have the most precise data available for planning a procedure, and know where error can occur in collecting the data.Each author certifies that he or she has no 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.

show abstract

“…Bernese periacetabular osteotomy, developed by Ganz [7] and modified by Millis and Murphy [13], has many advantages compared with previously described reorientation osteotomies [19].…”

Section: Discussionmentioning

confidence: 99%