Surgical dislocation and periacetabular osteotomy through a posterolateral approach: a cadaveric feasibility study and initial clinical experience

Abstract

Since its introduction, Bernese periacetabular osteotomy with a modified Smith-Petersen approach has become a successful strategy for the treatment of insufficient femoral head coverage in developmental dysplasia of the hip. Additionally, femoro-acetabular impingement secondary to acetabular retroversion has been effectively treated by this technique. Although the vascularity of the osteotomized acetabular fragement has not been a problem with the modified Smith-Petersen approach for the Bernese periacetabular osteotomy, little information is available on the vascularity of the periacetabular bone after an osteotomy through a posterolateral approach. Such an approach would allow for improved treatment of certain intraarticular pathologies while simultaneously providing the option of performing an acetabular osteotomy. This study was designed to determine the vascularity of the external periacetabular bone with a colored latex injection technique into the common iliac artery in 16 fresh cadavers. Additionally, in 7 injected cadavers, a periacetabular osteotomy was performed with a posterolateral approach. Our dissections demonstrated the technical feasibility of a juxta-acetabular osteotomy performed through a posterolateral approach. These dissections further demonstrated the importance of identifying and protecting the constant acetabular branch of the superior gluteal artery (present in 23 of 23 cases), which is necessary for preservation of the superior acetabular blood supply. The integrity of both the superior gluteal branch and the acetabular branch of the obturator artery were maintained in all 7 osteotomy cases. Thus, in indicated cases, a juxta-acetabular osteotomy can be safely executed and combined with a capsulotomy, femoral head dislocation, and femoral head/neck shaping procedure through a posterolateral approach.