Periacetabular Osteotomy in the Treatment of Severe Acetabular Dysplasia

Clohisy, John C.; Barrett, Susan E.; Gordon, Joel; Delgado, Eliana; Schoenecker, Perry L.

doi:10.2106/jbjs.e.00887

Cited by 94 publications

(126 citation statements)

References 24 publications

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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%

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%

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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show abstract

“…The primary indications for PAO included pain greater than 6 months [47,56], adequate ROM [3,27,47], radiographic evidence of residual hip dysplasia [2-4, 6, 7, 23, 27, 28, 45, 47, 50, 56, 57], and closure of triradiate cartilage [7,27]. In a number of studies [2,3,7,27,28,47,56,57], an abduction and internal rotation radiograph was used to determine if the femoral head would roll into the acetabulum and obtain the expected congruity after surgery.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…In a number of studies [2,3,7,27,28,47,56,57], an abduction and internal rotation radiograph was used to determine if the femoral head would roll into the acetabulum and obtain the expected congruity after surgery. The indications for surgery for RAO were similar to PAO [10,15,16,20,21,26,35,39,42,53,54,61,[63][64][65] (Table 1).…”

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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“…The Bernese periacetabular osteotomy (PAO) as described by Ganz et al [7] has become the preferred pelvic osteotomy in many centers for the treatment of symptomatic acetabular dysplasia in the young adult [2,3,5,16,18,[20][21][22]. Correcting the structural deformity improves pain and function for these patients, with greater than 90% of patients having substantial pain relief and improved function [2,3,5,16,18,21,22] However, the operation has been criticized by some because of its complexity and its lengthy learning curve [1,6,16].…”

Section: Introductionmentioning

confidence: 99%

“…Correcting the structural deformity improves pain and function for these patients, with greater than 90% of patients having substantial pain relief and improved function [2,3,5,16,18,21,22] However, the operation has been criticized by some because of its complexity and its lengthy learning curve [1,6,16].…”

Section: Introductionmentioning

confidence: 99%