Periacetabular osteotomy: a review of swiss experience

Abstract

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.

Hip Dysplasia in the Young Adult

“…These findings of poor joint congruity and the degree of arthritis as predictors of the short to mid-term outcome after periacetabular osteotomy have been reproduced by other groups 64,[80][81][82][83] . More recent reports on the results of periacetabular osteotomy from independent centers have focused on determining what clinical factors affect not only joint survivorship but also patient function 64,79,[84][85][86][87][88][89][90][91] (Table III).…”

Delays in diagnosis are associated with poorer outcomes in adult hip dysplasia

“…This conforms to the natural history of hip dysplasia, in that osteoarthritis will develop secondary to overloading of the acetabular rim. 5,6,8 Also, many patients will have suffered prolonged periods of hip pain unnecessarily. Pelvic radiographs taken at the onset of symptoms by the GP and reviewed by an experienced clinician may help reduce these delays.…”

“…6 Up to 50% of patients will suffer advanced osteoarthritis by age 50, 6 and this rises to 100% when subluxation of the femoral head occurs. 5,7 This can be attributed to a reduction in the load-bearing surface of the hip and subsequent increase in joint forces, previously described by Klaue et al. 8 as ‘acetabular rim syndrome.’…”

“…Developmental dysplasia of the hip (DDH) is a common cause of osteoarthritis in young adults. 1,2 The relatively shallow acetabulum found in dysplasia, which leads to a lack of femoral head coverage, can be demonstrated radiographically through a number of measurements on plain pelvic films, including the lateral centre edge angle of Wiberg 3 and the acetabular index, 4,5 which remain the mainstay of diagnosis. Patients with a relatively small lateral centre edge angle have been shown to develop advanced osteoarthritis earlier.…”

Arthroscopic Management of Dysplastic Hip Deformities

“…9,14,17 PAO is the current gold standard for the treatment of moderate to severe acetabular dysplasia, with a reported survival of the native hip joint in 60% of patients at 20-year follow-up. 1,21 Arthroscopy is considered an alternative surgical option for the treatment of select cases of milder hip dysplasia; however, the indications to date are not delineated. 2-4,14,17 Although poorly defined, radiographic parameters that may indicate “borderline” or milder degrees of hip dysplasia include an LCEA between 20° and 25°, an anterior center-edge angle between 15° and 20°, and/or a Tönnis angle (acetabular inclination) between 10° and 15°.…”