Abstract
Objective: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods: We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results: Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions: We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. Evidence Level: IV, Cadaveric Study.
Highlights
In 1988, Ganz et al.[1] first described the Bernese periacetabular osteotomy (PAO) technique
The final osteotomy began just below the anterior superior iliac spine (ASIS) and extended vertically, along the inner pelvic wall and finishing 1cm short of the margin of the posterior column, where it connected with the retroacetabular cut that was previously done from the posterior approach
A transverse intra-articular extension was observed after dissection and surgical hip dislocation. (Figure 3) In two cases, these fractures were non-displaced and only visible after meticulous dissection and manipulation
Summary
In 1988, Ganz et al.[1] first described the Bernese periacetabular osteotomy (PAO) technique Today, it is widely recognized as an effective technique for the treatment of painful, non-arthritic, dysplastic hips.[2] In this patient group, early symptoms are caused by structural instability and acetabular rim overload, sometimes with labral hypertrophy and tearing. It is widely recognized as an effective technique for the treatment of painful, non-arthritic, dysplastic hips.[2] In this patient group, early symptoms are caused by structural instability and acetabular rim overload, sometimes with labral hypertrophy and tearing These changes usually cause pain before arthritic changes ensue. Surgeons advocated the use of fluoroscopic imaging to facilitate the osteotomy
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