Ganz and colleagues described a new periacetabular osteotomy for adolescents and adults with residual acetabular dysplasia and reported its early results.
Technique report with cadaveric perfusion studies in 20 specimens and a preliminary series of 75 osteotomies performed since 1984.
Methods
Indication
Residual hip dysplasia
Adolescents and adults
Approach
Smith‑Petersen approach for capsule exposure and all cuts around the acetabulum
Posterior column left intact
Fragment fixed with two screws
Partial weight bearing (10 kg) from day 3 without immobilization
Outcomes
VCE angle of Wiberg
VCA angle of Lequesne and de Seze (sagittal plane)
Fragment perfusion in cadaver injection studies
Complications
Key Findings
Across the 75 osteotomies, mean correction was 31° for the VCE angle and 26° for the sagittal VCA angle, from preoperative values as low as −28° and −21°.
Injection and dissection studies in 20 cadavers showed adequate perfusion of the acetabular fragment, and no clinical case showed vascular impairment of the fragment.
Complications included 2 cuts that entered the joint, 1 femoral nerve palsy that recovered and 1 nonunion, and 13 patients needed their screws removed.
Ectopic bone limited flexion to 90° in 4 patients, and none clinically relevant was seen after the authors began transosseous muscle reattachment and routine indomethacin.
All clinically significant complications occurred in the first 18 operations, and blood loss fell from as much as 3000 cc early on to an average of 800 cc in the last 10 patients.
Labral avulsion was found in the oldest patient (56 years) and documented in 16 other dysplastic hips.
Board pearl
The Bernese osteotomy leaves the posterior column intact, so two screws hold the fragment and early weight bearing is possible. It also leaves the true pelvis unaltered, permitting normal childbirth.
Authors' conclusion
The periacetabular osteotomy presented here can, with careful planning and execution, be used to obtain more satisfactory and more anatomic correction of hip dysplasias.
Ganz and colleagues described a new periacetabular osteotomy for adolescents and adults with residual acetabular dysplasia and reported its early results.
Technique report with cadaveric perfusion studies in 20 specimens and a preliminary series of 75 osteotomies performed since 1984.
Methods
Indication
Residual hip dysplasia
Adolescents and adults
Approach
Smith‑Petersen approach for capsule exposure and all cuts around the acetabulum
Posterior column left intact
Fragment fixed with two screws
Partial weight bearing (10 kg) from day 3 without immobilization
Outcomes
VCE angle of Wiberg
VCA angle of Lequesne and de Seze (sagittal plane)
Fragment perfusion in cadaver injection studies
Complications
Key Findings
Across the 75 osteotomies, mean correction was 31° for the VCE angle and 26° for the sagittal VCA angle, from preoperative values as low as −28° and −21°.
Injection and dissection studies in 20 cadavers showed adequate perfusion of the acetabular fragment, and no clinical case showed vascular impairment of the fragment.
Complications included 2 cuts that entered the joint, 1 femoral nerve palsy that recovered and 1 nonunion, and 13 patients needed their screws removed.
Ectopic bone limited flexion to 90° in 4 patients, and none clinically relevant was seen after the authors began transosseous muscle reattachment and routine indomethacin.
All clinically significant complications occurred in the first 18 operations, and blood loss fell from as much as 3000 cc early on to an average of 800 cc in the last 10 patients.
Labral avulsion was found in the oldest patient (56 years) and documented in 16 other dysplastic hips.
Board pearl
The Bernese osteotomy leaves the posterior column intact, so two screws hold the fragment and early weight bearing is possible. It also leaves the true pelvis unaltered, permitting normal childbirth.
Authors' conclusion
The periacetabular osteotomy presented here can, with careful planning and execution, be used to obtain more satisfactory and more anatomic correction of hip dysplasias.