The incidence of stress fracture following peri-acetabular osteotomy

Malviya, Ajay; Dandachli, Wael; Beech, Z; Bankes, Marcus; Witt, Johan

doi:10.1302/0301-620x.97b1.34525

Cited by 32 publications

(29 citation statements)

References 17 publications

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“…There were no patients who had further surgery for impingement nor any stress fractures at the osteotomy sites [13]. We would hence advise to err on the side of caution regarding the amount of correction achieved.…”

Section: Discussionmentioning

confidence: 99%

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Grammatopoulos

Wales

Kothari

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described. Questions/purposes The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction. Methods The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle\25°and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study's mean followup was 8 years (range, 2-18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0-96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software. Results The 10-year survival rate was 93% (95% confidence interval [CI], 82%-100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0-54 Conclusions This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Grammatopoulos

Wales

Kothari

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Another important issue has been explored by Malviya et al, 35 who analysed the incidence of stress fracture after PAO under the care of two high-volume surgeons (359 patients included, mean age 31.1 years (15 to 56), with a mean follow-up of 26 months). Eighteen percent of the patients developed a stress fracture of the inferior pubic ramus, which was noted radiologically at a mean of 9.1 weeks after surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 8 , 25 - 33 The learning curve related to the occurrence of complications affects the outcome in some studies. 8 , 29 , 34 Stress fracture of the ischium has recently been reported to occur in 18% 35 and obesity has recently been shown to increase the risk of a serious complication by 11 times. 36 …”

Section: Developmental Dysplasia Of the Hip: Periacetabular Osteotomymentioning

confidence: 99%

The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

et al. 2018

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Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI).Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain.Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis.Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO).FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery.If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO.THA can be performed following PAO with outcomes similar to a primary THA.Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears.Cite this article: EFORT Open Rev 2018;3:408-417. DOI: 10.1302/2058-5241.3.170042

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“…54,55 The risk of major arterial injury is low with MSP and MIS approaches as compared with ilioinguinal approach which has been reported to have a higher incidence of femoral artery thrombosis. 11,27 Malviya et al 56 analysed the incidence of stress fracture after PAO in 359 patients. They found that 18.4% developed a stress fracture of the inferior pubic ramus, which was noted at a mean of 9.1 weeks after surgery.…”

Section: Not Reportedmentioning

confidence: 99%

Complications and outcome after periacetabular osteotomy - influence of surgical approach

Ali

Malviya

2019

HIP International

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Background: Bernese periacetabular osteotomy (PAO) was introduced by Ganz as a novel surgical technique for hip dysplasia with a congruent hip to reorient the acetabulum in skeletally mature patients. The PAO through a modified Smith-Petersen (Iliofemoral) approach, has been subject to many modifications in order to avoid complications and to minimise risks for failure. Aim: The aim of this review was to report on the complication rates, functional and radiological outcomes in relation to surgical approaches. Methods: A search of NICE healthcare database advanced search, was conducted from the year of inception to May 2018. We included studies that reported complications of PAO. Data extracted from case series was analysed to detect the incidence of complications, relation to surgical approach and temporal trend of complications. Results: 40 studies including 4070 hips with a mean age of 29 years and a mean follow-up of 52.8 month, were analysed. Outcome measures demonstrated good to excellent outcome in 82%. Higher rates of LFCN and sciatic nerve injuries were found to be associated with the ilioinguinal and the 2-incision approach. Minimally invasive (MIS) modified Smith-Petersen (MSP), minimally invasive trans-sartorial and trans-trochanteric approaches were not reported to be associated with any major wound complications. Radiological correction achieved with a mean improvement in acetabular inclination of 17.90 (range 4.5–40), anterior centre-edge correction 25.40 (range 10–51), lateral centre-edge correction 23.30 (range 15–44.6) and medial translation of 6 mm (range 3.2–10). Conclusions: The complication rates seem to be lower in this current review (7%) as compared to the previous review performed by Clohisy et al. (6–37%). The MIS trans-sartorial/MIS MSP and intertrochanteric approaches are associated with an even reduced complications rates. This review enables favouring the minimally invasive approaches with regard to reducing nerve injury and wound complications.

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The incidence of stress fracture following peri-acetabular osteotomy

Cited by 32 publications

References 17 publications

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

Complications and outcome after periacetabular osteotomy - influence of surgical approach

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