Prevention of Nerve Injury After Periacetabular Osteotomy

Sierra, Rafael J.; Beaulé, Paul E.; Zaltz, Ira; Millis, Michael B.; Clohisy, John C.; Trousdale, Robert T.

doi:10.1007/s11999-012-2409-1

Cited by 50 publications

(32 citation statements)

References 15 publications

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“…A narrow subgluteal window is elevated with a blunt distractor placed in the sciatic notch to protect the abductors and sciatic nerve from the oscillating saw during osteotomy of the supraacetabular ilium. Because of the limited overview, the incidence of sciatic nerve injuries has increased compared with the initial technique [53]. 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.…”

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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Section: Approachmentioning

confidence: 99%

Periacetabular osteotomy: a review of swiss experience

Büchler

Beck

2014

Curr Rev Musculoskelet Med

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“…Complications, such as neurovascular injuries, massive blood loss, technical faults, and malposition, can be avoided when following the key points of PAO. Cadaveric practice and familiar with the local anatomy can help the surgeon learn the technique quickly.…”

Section: Discussionmentioning

confidence: 99%

“…Be sure to use the preoperative morphologic character of the obturator foramen on the pelvic X-ray as a basic reference to avoid the malposition of the acetabular fragment. Complications [6][7][8][9] , such as neurovascular injuries, massive blood loss, technical faults, and malposition, can be avoided when following the key points of PAO. Cadaveric practice and familiar with the local anatomy can help the surgeon learn the technique quickly.…”

Section: Discussionmentioning

confidence: 99%

Efficiency and Accuracy of Bernese Periacetabular Osteotomy for Adult Hip Dysplasia

Luo

Zhao

Xiao

et al. 2015

Orthopaedic Surgery

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Bernese periacetabular osteotomy (PAO) has several advantages dealing with adolescents and adults acetabular dysplasia. The authors introduced the details and steps performing PAO, with attached video and schematic diagram which demonstrates a perfect PAO in efficiency and accuracy. The patient is an 18‐year‐old girl, complaining hip pain on the left side for 6 months. Physical examination shows normal gait and range of motion (ROM) of the left hip. Pelvic anteroposterior X‐ray shows acetabular dysplasia on the left, and post operation on the right. She is very satisfied with the PAO on the right one year before, so we recommend PAO for the left hip dysplasia again. The key point of PAO includes 4 cuts: ischial cut, pubic cut, acetabular roof cut, and quadrilateral bone cut, and the four cuts should be accomplished accurately. Then the acetabular fragment should be turned to ideal position with the lateral CE angle (LCE) > 25°, the Tönnis acetabular angle 0°, the anterior CE angle (ACE) > 20°, good congruence joint space, and with the hip center medialized slightly. At lastly the acetabular fragment is fixed with proper nails and instruments. The patient is very happy to the surgery with no hip pain, with normal gait, ROM, and Harris hip scores (HHS). In summary, PAO is a relative new and efficient procedure for adult hip dysplasia, requiring accurate techniques. Cadaveric practice and familiar with the local anatomy can help the surgeon overcome the learning curve quickly.

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“…They were unable to determine which patients are at increased risk of nerve injury at the time of PAO. Femoral nevre injuries have a good prognosis whereas the degree of neurologic recovery of sciatic nerve injuries depends on the cause and severity of the damage [7]. In particular the lateral cutaneous nerve is prone to injury reportedly in up to one-third of patients but regarded as a minor problem and given only little attention by the surgeon.…”

Section: Discussionmentioning

confidence: 99%

The Femoral and Lateral Femoral Cutaneous Nerve Palsy After Periacetabular Osteotomy Operation

et al. 2015

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Acetabular dysplasia is a complex multi-plane deformity of the acetabulum, which results in the development of osteoarthritis at an early age in young adults. A female patient at age of 24 was admitted to our rehabilitation clinic because of hip pain and weakness. The patient had had bilateral hip joint dysplasia and she had been operated from right side on December 25, 2013 by Ganz tecnique which is called periacetabular osteotomy. After the surgery, the patient had limitation of hip joint and limping. When the patient was admitted to our clinic, the patient's hip muscles force was 2/5, knee muscles force was 5/5 and she has hypoesthesia at L2-3 dermatomes. Her EMG result exposed femoral and lateral femoral cutaneous nerve injury. The patient could walk with a canedien. We took the patient for rehabilitation treatment to strengthen her muscles and to decrease hip pain and hip limitation. The aims of treatment for acetabular dysplasia are the normalization of the relationship between the femoral head and acetabulum on weight bearing position, and to provide a painless, stable, and functional hip in the long term. There may be several complications after hip surgery such as nerve or vessel injury, acetabular osteonecrosis, arthrosis, intraarticular osteotomy, heterotopic ossification, pulmonary emboli, deep vein thrombosis (DVT), and RSDS (algoneurodistrofia).

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Prevention of Nerve Injury After Periacetabular Osteotomy

Cited by 50 publications

References 15 publications

Periacetabular osteotomy: a review of swiss experience

Periacetabular osteotomy: a review of swiss experience

Efficiency and Accuracy of Bernese Periacetabular Osteotomy for Adult Hip Dysplasia

The Femoral and Lateral Femoral Cutaneous Nerve Palsy After Periacetabular Osteotomy Operation

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