Bernese Periacetabular Osteotomy Research Articles

Functional and radiological outcomes and complications of bernese periacetabular osteotomy through modified Stoppa approach.

The Smith-Peterson approach and its modifications provide an extensive exposure and allow osteotomies through a single incision. However, the risk of complications increases when the quadrilateral surface, ischial and pubic osteotomy sites cannot be seen. This study aimed to evaluate the surgical characteristics, complications, and functional and radiological outcomes of patients with acetabular dysplasia who underwent Bernese periacetabular osteotomy (PAO) through modified Stoppa approach and plate-screw fixation. The study included 31 patients (41 hips) who had undergone PAO using a modified Stoppa approach. The characteristics of patients and the surgical procedure were described. The lateral centre-edge angle (LCEA) and Tönnis roof angle were evaluated in the radiological outcome evaluation. The modified Harris Hip Score (mHHS) was used to evaluate functional outcome. Furthermore, complications were described. The mean age of the patients was 20.4 ± 9.0 years. Of the 31 patients, 21 underwent unilateral Bernese PAO and 10 underwent bilateral Bernese PAO. The mean follow-up period was 25.1 ± 8.8 months. Postoperatively, the mean mHHS improved significantly (68.8 ± 9.4 vs. 88.8 ± 10.0, p < 0.001). Postoperatively, the mean LCEA and Tönnis roof angle improved significantly (17.7 ± 6.0 vs. 42.2 ± 4.8, p < 0.001 for LCEA and 18.3 ± 5.5 vs. 8.0 ± 2.2, p < 0.001 for Tönnis roof angle). There was no significant correlation between preoperative to postoperative improvement in LCEA or Tönnis roof angle and improvement and mHHS (p > 0.005). 5 complications were identified: 1 transient sciatic nerve palsy, 1 external iliac vein injury, 1 infection, and 2 screw irritations of acetabulum. Performing Bernese PAO through a modified Stoppa approach with plate-screw fixation results in acceptable complication rates, immediate early weight-bearing opportunity, and improved functional and radiological outcomes in patients with acetabular dysplasia.

Three-dimensional acetabular reorientation during periacetabular osteotomy: an intraoperative navigation method using an external fixator for periacetabular osteotomy.

Bernese periacetabular osteotomy (PAO) is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection or changes in acetabular version resulting in residual dysplasia or femoroacetabular impingement. Thus, we wanted to develop a simple and straightforward navigation method that provides information about acetabular correction in all three planes during surgery. Intraoperatively, acetabular coordinates are shown in coronal, sagittal, and transverse plane by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the mobilized acetabular fragment with two Schanz screws. The application and fixation of the external fixator on the pelvis are demonstrated in this article. We used this analog navigation method on 27 PAOs, where we mainly performed a lateral rotational correction. The pre- and postoperative radiographs of these 27 hips were analyzed regarding the radiological hip parameters, taking into account the pelvic tilt. The mean preoperative lateral center edge angle (LCEA) of the 27 PAOs improved from 16° (+-6) to a mean of 34° (+-6°) and the mean acetabular index (AI) was corrected from 15° (+-4) to 2° (+-4). This implements highly physiologic postoperative values for lateral coverage in this population. In this case series, no postoperative acetabular retroversion was measured in any of the 27 PAOs. Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and undercorrection. Using a fixateur externe as an analog navigation method this three-dimensional control can be implemented intraoperatively for PAOs.

MCKIBBIN INDEX AND FEMORAL VERSION NOT PREDICTIVE OF IHOT12 CHANGE AT TWO YEARS IN PATIENTS UNDERGOING ISOLATED PERIACETABULAR OSTEOTOMY

Adult hip dysplasia AHD is a complex 3D pathology of lateral coverage, version and/or volume and is often associated with increased femoral anteversion. The Mckibbin index MI is the combination of acetabular version AV and femoral version FV and is used as a measure of anterior hip Stability/ Impingement(1). The Bernese Periacetabular osteotomy PAO is a powerful tool in treating AHD, but it does not address FV. De-rotational femoral osteotomies FO increases risk of complications, operative time and might condemn the patient to Secondary osteotomies to balance the gait. We aim to investigate the effect of MI and FV on PROMs in patients undergoing PAO only.593 PAOs identified on the Local Hip preservation registry between 01/2013 and 7/2023. PAOs for retroversion, residual Perthes and those combined with FO were excluded. Patients with no available PROMS at 2 years were excluded. Independent variables were collected from E-notes and imaging including MI and FV. A multiple linear regression analysis was performed against preoperative iHot12, and iHot12 change at 2years.The mean FV was 18.86± 12.4 SD. Mean MI was 36.07, SD 15.36. Mean preop iHot12 score was 29.83 ± 17.38 SD. Mean change in iHot12 at 2 years was+36.47 ± 28.44 SD. Females and a higher BMI were statistically correlated to a lower preoperative iHot12. A lower preop iHot12 score and a higher preop AI were correlated to a bigger change in iHot12 at 2years with statistical significance. MI and FV were not found to have a statistically significant correlation with Outcome measures,An increased Mckibbin index and femoral anteversion were not correlated with worse outcomes at two years. PAO alone in the presence of increased femoral anteversion avoids risks associated with FO which can be performed later if required.

The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates

PurposeTo analyze annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as post-operative outcomes, including ipsilateral reoperations. MethodsNinth and Tenth Revision codes of the International Classification of Diseases were used to query the PearlDiver™ Mariner database from January 2010 through January 2022 to identify patients aged 10-59 years who had a presenting diagnosis of HD and subsequently underwent: 1) HA; 2) PAO; or 3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days following HA). We analyzed annual rates for each treatment, as well as rates of post-operative emergency visits, readmissions and five-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). ResultsThere were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the highest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, while PAO peaked in 2019. For HA, PAO, and HA-PAO, the majority of cases were performed in female patients and patients aged 30-49 years, 10-19 years, and 10-29 years, respectively. The five-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% CI: 8.6%- 9.8%) in the HA group and 6.5% (95% CI: 4.1%- 8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the highest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. ConclusionHA is more frequently performed than PAO for hip dysplasia. HA-PAO is rising at the greatest rate, demonstrating fewer complications and reoperations.

Periacetabular osteotomy: an analysis of social media to determine the most common questions asked by the periacetabular osteotomy population

BackgroundThe Bernese Periacetabular Osteotomy (PAO) has become a popular surgery for fixing development dysplasia of the hip, yet the most common concerns of the PAO population remains ambiguous. The aim of this study was to investigate Facebook, Instagram and Twitter to further understand what the most common preoperative and postoperative questions patients undergoing PAO are asking. We hypothesized most questions would be asked by patients in the preoperative timeframe with regards to education surrounding PAO surgery.MethodsFacebook, Instagram and Twitter were queried consecutively from February 1, 2023 to November 23, 2011. Facebook was searched for the two most populated interest groups; “Periacetabular Osteotomy (PAO)” and “Periacetabular Osteotomy Australia”. Instagram and Twitter were queried for the most popular hashtags: “#PAOwarrior”, “#PAOsurgery”, “#periacetabularosteotomy”, “#periacetabularosteotomyrecovery”, and “#paorecovery”. Patient questions were categorized according to preoperative and postoperative questions. Questions were further placed into specific themes in their respective preoperative or postoperative question types.ResultsTwo thousand five hundred and fifty-nine posts were collected, with 849 (33%) posts containing 966 questions. Of the 966 questions, 443 (45.9%) and 523 (54.1%) were preoperative and postoperative questions, respectively. The majority of questions were postoperative complication related (23%) and symptom management (21%). Other postoperative questions included recovery/rehabilitation (21%), and general postoperative questions (18%). The most common preoperative questions were related to PAO education (23%). Rehabilitation (19%), hip dysplasia education (17%), and surgeon selection (12%) were other preoperative questions topics included. Most questions came from Facebook posts. Of 1,054 Facebook posts, 76% were either preoperative or postoperative questions and from the perspective of the patient (87%).ConclusionThe majority of patients in the PAO population sought advice on postoperative complications and symptom management. Some patients asked about education surrounding PAO surgery. Understanding the most common concerns and questions patients have can help providers educate patients and focus on more patient-relevant perioperative conversations.

Construction of a predictive nomogram for functional recovery after Bernese periacetabular osteotomy.

Surgical indications for Bernese periacetabular osteotomy (PAO) are well-established. However, the extent of postoperative functional recovery varies widely, as observed in clinical follow-ups. Thus, preoperative evaluation is crucial. This study aims to identify factors that influence functional recovery post-PAO and to develop a predictive nomogram. Retrospective data were collected between December 2016 and March 2022 at The First Affiliated Hospital of Shandong First Medical University. The dataset included demographic and imaging data of patients who underwent PAO. The least absolute shrinkage and selection operator (LASSO) regression was utilized to identify influencing factors, which were further analyzed using multivariate logistic regression to construct a predictive nomogram for post-PAO functional recovery. The analysis identified critical factors affecting functional recovery post-PAO, namely, the preoperative distance from the innermost surface of the femoral head to the ilioischial line, the surgical approach, preoperative acetabular depth, and the continuity of the preoperative Calve line. A nomogram was developed using these significant predictors. The model's validity was demonstrated by the receiver operating characteristic curve, with an area under the curve of 0.864. Additionally, the calibration curve confirmed the nomogram's accuracy, showing a strong correlation between observed and predicted probabilities, indicating high predictive accuracy. This predictive nomogram effectively identifies patients most suitable for PAO, providing valuable guidance for selecting surgical candidates and determining the appropriate surgical approach.

Prevention ofmotor ascending branch ofthe rectus femoris injuries inBernese periacetabular osteotomy: a cadaveric study.

The Bernese periacetabular osteotomy (PAO) is a surgical procedure used to treat hip dysplasia in young adults, but it carries the risk of neurological complications, including injury to the motor ascending branch of the rectus femoris (MABRF). This study aimed to describe anatomical considerations to prevent MABRF injuries during PAO. A cadaveric study was conducted on seven specimens. The original and modified PAO approaches were used, with and without disinsertion of the rectus femoris muscle origin. The femoral nerve was dissected in all specimens from the endopelvic position to the MABRF origin (T-point). The average distance from the anterosuperior iliac spine to the T-point was 10.2 ± 0.4 cm. To protect the MABRF, a safety zone was identified for the osteotome placement during the ischial cut. The osteotome was slid over the joint capsule, deflecting the iliocapsularis muscle medially and distally. This manoeuvre shields the MABRF with the iliocapsularis muscle, reducing the risk of neurological injury. Both the original and modified PAO approaches were considered safe techniques with low risk to the rectus femoris innervation. These findings offer valuable insights for surgeons performing PAO, emphasizing the significance of understanding anatomical relationships and implementing protective measures to enhance patient outcomes and minimize complications. In conclusion, implementing these anatomical considerations can help prevent MABRF injuries during PAO, contributing to safer and more successful surgical interventions for hip dysplasia in young adults.

A bibliometric analysis andvisualization ofresearch trends onperiacetabular osteotomy.

Bernese periacetabular osteotomy (PAO) is a practical and safe acetabular reorientation technique used to correct structural hip deformities, and much relevant literature has been published over the past decades. This bibliometric study aims to determine the status of PAO research between 1994 and 2022. Information about PAO research publications from 1994 to 2022 was obtained from the Web of Science Core Collection. This bibliometric study is implemented and analyzed through three bibliometric tools with respect to publication counts, countries, institutions, authors, journals, funding agencies, references and keywords. In total, 634 publications concerning PAO were identified. The United States and Washington University in St. Louis have published the most literature in terms of country and institution. Additionally, Switzerland and the University of Bern are the country and the institution with the highest average number of citations in the PAO field. The most published and co-cited journal is Clinical Orthopaedics and Related Research. Burst keyword detection has discovered that 'patient-reported outcome', 'instability', 'risk', 'survivorship' and 'outcome' are regarded as the current research frontier. In summary, our findings provide insight into the bibliometric overview of research status in the PAO field, which may offer later investigators' references in exploring further research directions.

Step-cut osteotomy of the anterior superior iliac spine for increased visualisation in the Levine approach for Bernese periacetabular osteotomy surgery.

Hip dysplasia can lead to pain and dysfunction in the young adult. Acetabular undercoverage leads to abnormal joint loading and results in joint degeneration, accelerating need for arthroplasty in this patient population. Conceptually, treatment focuses on increasing acetabular coverage in the form of periacetabular osteotomy. The procedure can be performed through the iliofemoral approach, and performing an anterior superior iliac spine (ASIS) osteotomy can enhance the visualisation in this approach. Several techniques have been described for ASIS osteotomy. The purpose this study was to report on step-cut technique for ASIS osteotomy during the Bernese periacetabular osteotomy procedure to enhance visualisation when utilising the iliofemoral approach. This step-cut technique enhances stability at the osteotomy site, and minimises soft tissue dissection to reduce pain and assists with maintaining a stable fixation construct postoperatively. There were no nonunions and minimal morbidity to the lateral femoral cutaneous nerve injury in cohort of 86 patients while utilising this technique. We recommend using this step-cut ostetomy of the ASIS during Bernese periactetabular osteotomy for benefit of increasing exposure while maintaining a low complication profile.

The favorable outcome of Bernese periacetabular osteotomy for the hip osteoarthritis in multiple epiphyseal dysplasia

BackgroundMultiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as the third to the fourth decade. Currently, there is no consensus on the prevention of the progressive hip osteoarthritis secondary to MED. The Bernese periacetabular osteotomy (PAO) is a joint-preserving surgery to reshape acetabulum and extend femoral head coverage. However, there is no documentary evidence for the effect of the procedure on MED hips.Patients and methodsWe analyzed the preliminary outcomes following the Bernese PAO in 6 MED hips. The average age at the time of surgery was 14.3 years (range from 11.4 to 17.2 years). For our study interest of time efficiency, radiographic parameters were analyzed preoperatively and 1 year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery.ResultsThe mean follow-up time was 1.7 years. The mean lateral center–edge angle increased from 3.8° to 47.1° (p = 0.02), anterior center–edge angle increased from 7.3° to 35.1° (p = 0.02), and acetabulum index decreased from 27.8° to 14.6° (p = 0.04). The femoral head coverage ratio increased from 66.8% to 100% (p = 0.02). The post-operative anteroposterior pelvic radiograph demonstrated all preoperative broken Shenton lines were reversed. The mean HHS improved from 67.3 to 86.7 (p = 0.05).ConclusionBernese PAO is a feasible treatment for hip disorders in MED patients. It reshapes acetabular and femoral morphology efficiently. In our study, the preliminary results showed the procedure not only improved radiographic outcomes but also hip function.

Pelvic tilt after Bernese periacetabular osteotomy-a long-term follow-up study.

Patients with developmental dysplasia of the hip (DDH) are believed to present with increased anterior pelvic tilt to compensate for reduced anterior femoral head coverage. If true, pelvic tilt in dysplastic patients should be high preoperatively and decrease after correction with periacetabular osteotomy (PAO). To date, the evolution of pelvic tilt in long-term follow-up after PAO has not been reported. We therefore asked the following questions: (i) is there a difference in pelvic tilt between patients with DDH and an asymptomatic control group? (ii) How does pelvic tilt evolve during long-term follow-up after Bernese PAO compared with before surgery? This study is a therapeutic study with the level of evidence III. We retrospectively compared preoperative pelvic tilt in 64 dysplastic patients (71 hips) with an asymptomatic control group of 20 patients (20 hips). In addition, immediate postoperative and long-term follow-up (at 18 ± 8 [range 7-34 years) pelvic tilt was assessed and compared. Dysplastic patients had a significantly higher mean preoperative pelvic tilt than controls [2.3 ± 5.3° (-11.2° to 16.4°) versus 1.1 ± 3.0° (-4.9 to 5.9), P = 0.006]. Mean pelvic tilt postoperatively was 1.5 ± 5.3° (-11.2 to 17.0º, P = 0.221) and at long-term follow-up was 0.4 ± 5.7° (range -9.9° to 20.9°, P = 0.002). Dysplastic hips undergoing PAO show a statistically significant decrease in pelvic tilt during long-term follow-up. However, given the large interindividual variability in pelvic tilt, the observed differences may not achieve clinical significance.

Functional outcome and athletic level after arthroscopic repair followed by triple pelvic osteotomy in patients with labral tears resulting from acetabular dysplasia.

Patients with acetabular dysplasia are at ahigher risk of developing symptomatic labral tears. Isolated treatments that address these pathologies are well established. Combined treatment with hip reorientation osteotomy using Bernese periacetabular osteotomy in addition to arthroscopic labral repair show good results. Studies that report the outcome in patients who received both arthroscopic labral repair and atriple pelvic osteotomy (TPO) are lacking. The aim of this study is to investigate the short to midterm functional outcome and activity level in these patients. This case series retrospectively included 8patients (2male, 6female) with acetabular dysplasia (lateral center-edge angle [LCEA] ≤ 25°) and alabral tear on magnetic resonance arthrography (MRA). All patients underwent arthroscopic labral repair followed by TPO after an average period of 3months (range 2-6). Average age at the time of surgery was 25years (range 15-37). Patients were followed up and the following main parameters were assessed: LCEA, modified Harris hip score (mHSS), Tegner score, UCLA score, patient satisfaction on ascale of 1-4. The mean follow-up was 19months (range 15-25). The mean LCEA increased from 18° to 37° (p < 0.0001). The mHSS improved from amean of 79 to 94 on final follow-up (p = 0.00123). The Tegner and UCLA scores had amedian of 4 and 5, respectively. The mean LCEA increased from 18° to 37° (p < 0.0001). The mean patient satisfaction was 3.6. Patients with evidence of alabral tear resulting from acetabular dysplasia benefit from arthroscopic repair followed by aTPO. The literature still lacks evidence that labral repair and reorientation osteotomy produce superior outcome compared to osteotomy alone. Treatment should consider clinical presentation in addition to radiological findings with emphasis on MRA.

Current Surgical Techniques in the Treatment of Adult Developmental Dysplasia of the Hip.

The surgical protocols currently used for the treatment of developmental dysplasia of the hip (DDH) are varied, with sufficient differences in clinical outcomes that warrant a review of the role of practicing orthopedic surgeons. This paper aims to summarize the current novel techniques within the realm of surgical treatment for adult DDH, thus serving as a guide to surgeons looking to quickly familiarize themselves with available techniques. We performed computer systematic literature searches of the Embase and PubMed databases from 2010 to 2 April 2022. Study parameters as well as their respective patient reported outcomes (PROMs) were described in detail and compiled into diagrams. Two novel techniques were identified for the treatment of borderline or low-grade DDH. Six techniques which included modifications to the Bernese periacetabular osteotomy (PAO) were identified for the treatment of symptomatic DDH. Three techniques which include combinations of arthroscopy and osteotomy were identified for the treatment of DDH with concomitant hip pathologies such as cam deformities. Finally, six techniques, all of which are modifications to total hip arthroplasty (THA), were identified for the treatment of high-grade DDH. The techniques detailed in this review therefore equip surgeons with the necessary knowledge to improve outcomes in patients with varying degrees of DDH.

Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia in Patients ≥40 Years Old: Intermediate and Long-Term Outcomes and Predictors of Failure.

The Bernese periacetabular osteotomy (PAO) is controversial as a treatment for symptomatic acetabular dysplasia in patients ≥40 years of age. We conducted a retrospective study to evaluate the outcomes, measure the survival rate, and identify factors associated with PAO failure in patients ≥40 years of age. We performed a retrospective study of patients ≥40 years of age undergoing PAO. Study eligibility criteria were met by 166 patients (149 women; mean age, 44 ± 3 years), and 145 (87%) were followed for ≥4 years after PAO. We used a Kaplan-Meier curve with right-censoring to calculate survivorship, with "failure" defined as either conversion to or recommendation for total hip arthroplasty or a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score of ≥10 at the most recent follow-up. We used simple logistic regression models to determine whether any preoperative characteristics were significantly associated with PAO failure. The median follow-up time was 9.6 years (range, 4.2 to 22.5 years). Sixty-one of 145 hips (42%, 95% confidence interval [CI] = 34% to 51%) experienced PAO failure during follow-up. The median survival time was 15.5 years (95% CI = 13.4 to 22.1 years). The median survival time was longer for hips with no or mild preoperative osteoarthritis: 17.0 years for Tönnis grade 0, 14.6 years for grade 1, and 12.9 years for grade 2. Higher preoperative Tönnis arthritis grades (p = 0.03) and worse WOMAC function scores (p < 0.001) were associated with an increased likelihood of failure. PAO is usually effective at improving function and is effective at preserving the hip in patients ≥40 years of age provided that they have good preoperative function and no or mild preoperative osteoarthritis (Tönnis grade 0 or 1). Patients who are ≥40 years old with advanced preoperative osteoarthritis (Tönnis grade 2) and those with poor preoperative dysfunction have a high risk of therapeutic failure after PAO. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

The Impact of Pelvic Osteotomies on Birth Canal Anatomy and Cesarean Section Rates: A Systematic Review

Background: Various pelvic osteotomies can be performed to improve femoral head coverage for patients with hip dysplasia and other childhood hip disorders with the goal of delaying or preventing osteoarthritis. During preoperative discussions, female patients and their parents often ask about the influence of these osteotomies on future pregnancy. The literature on this topic is varied with no consensus on the appropriateness of elective cesarean section (C-section) for such patients. Therefore, this study sought to review and summarize the literature regarding the impact of different pelvic osteotomies on birth canal anatomy and C-section rates.Methods: All studies assessing the impact of pelvic osteotomies on birth canal anatomy or pregnancy outcomes for patients were identified through a systematic search of four online databases (PubMed, Embase, CINAHL, and Cochrane Library). PRISMA guidelines were then used to evaluate all identified studies for appropriateness, leading to the final inclusion of 17 articles evaluating five general types of pelvic osteotomies.Results: The Salter, double, and triple osteotomies were found to decrease the size of the pelvic outlet in modelbased and radiographic studies. The Chiari osteotomy decreased the dimensions of the pelvic inlet/mid-pelvis and was associated with higher reported C-section rates. The Bernese periacetabular osteotomy was not associated with any changes in pelvic diameters, with reported increased rates of C-section noted to result from obstetrician preference. For osteotomies performed prior to skeletal maturity, resulting pelvic deformities largely remodeled with growth.Discussion: Pelvic osteotomies can alter normal pelvic parameters and may influence the ability for vaginal delivery. Obstetricians may recommend C-section for patients undergoing non-PAO osteotomies depending on skeletal maturity status at the time of their osteotomy and other obstetric-related factors such as fetal size and natural pelvic relaxation. The literature on this subject, however, remains limited.Levels of Evidence: Level IVKey Concepts•Pelvic osteotomies for residual hip dysplasia or other childhood hip disorders alter normal pelvic parameters that may preclude the possibility of vaginal birth, particularly when performed after skeletal maturity.•The Chiari osteotomy primarily alters the dimensions of the pelvic inlet and mid-pelvis, while the Salter, double, and triple osteotomies decrease the size of the pelvic outlet.•The Bernese periacetabular osteotomy does not influence bony birth canal anatomy.•Pelvic deformities resulting from pelvic osteotomies performed before skeletal maturity often remodel with growth.•Obstetricians may recommend cesarean section after pelvic osteotomy, particularly when performed bilaterally, dependent on obstetric-specific factors.

Bernese Periacetabular Osteotomy in Patients with Hip Dysplasia Secondary to Cerebral Palsy and Developmental Dysplasia of the Hips

Bernese Periacetabular Osteotomy in Patients with Hip Dysplasia Secondary to Cerebral Palsy and Developmental Dysplasia of the Hips

What is the agreement between intraoperative fluoroscopy and postoperative radiographs in Bernese periacetabular osteotomy?

BackgroundIt is important to reorient the acetabular fragment into an optimal position and version to ensure a good long-term outcome after Bernese periacetabular osteotomy (PAO). Unfortunately, the intraoperative balance between overcorrection and undercorrection remains challenging for the surgeon. The purpose of this study was to answer two questions: (1) Does the femoral head coverage measured on intraoperative fluoroscopy agree with that measured on postoperative radiography? (2) What is the reliability of intraoperative fluoroscopy in identifying hip center correction in PAO?MethodsA total of 173 patients (173 hips) who underwent PAO for developmental dysplasia of the hip (DDH) at our center from July 01, 2020, to December 31, 2020, were retrospectively reviewed. Imaging data from 111 patients (female/male, 98/13; right/left, 72/39; mean age, 28.93 years) were included in this study. The analysis included measurement of the lateral center-edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI), extrusion index (EI), and medial offset distance (MO). These measurements were acquired from intraoperative fluoroscopic images and postoperative radiographs and compared by paired t test using SPSS (version 24.0). Significance was determined at a p value of < 0.05. Bland–Altman analysis, conducted using GraphPad Software (version 9), was used to quantify the agreement between intraoperative fluoroscopic images and postoperative radiographs.ResultsThe means (standard deviations, SDs) of the LCEA, AI, AWI, PWI, EI, and MO obtained on intraoperative fluoroscopy were 32.86° (5.73°), 0.66° (5.55), 0.29 (0.10), 0.75 (0.17), 11.15% (6.50%), and 8.49 mm (3.68 mm), respectively. On postoperative radiography, the corresponding values were 32.91° (6.31°), 1.63° (5.22°), 0.29 (0.15), 0.85 (0.14), 11.27% (7.36%), and 9.60 mm (3.79 mm). The differences in the LCEA, AWI, and EI acquired from intraoperative fluoroscopic images and postoperative radiographs were not significant (p = 0.90, 0.95, and 0.83, respectively), but those in the AI, PWI, and MO were significant (p < 0.05). The mean biases (95% limits of agreement) of the LCEA, AI, AWI, PWI, EI, and MO were − 0.04 (− 6.85), − 0.97 (− 7.78), 0 (− 0.30), − 0.11 (− 0.36), − 0.12 (− 11.92), and − 1.11 (− 5.51), respectively.ConclusionThe LCEA, EI, and AWI can be used to reliably predict postoperative femoral head coverage at the level of 2D graphics. Acetabular inclination can be cautiously assessed using AI on intraoperative fluoroscopy. In the absence of intraoperative 3D image evaluation, the AWI and PWI demonstrate acceptable agreement between fluoroscopy and radiography in assessing the acetabular version. Although the MO shows slight bias, it can be helpful in properly positioning the acetabulum during PAO.

Bernese Periacetabular Osteotomy: A Comparative Study of Four Types of Incisions.

Bernese periacetabular osteotomy has diverse complications associated with incisions, such as dehiscence, hypertrophy, depression, and hyperpigmentation on scars, which affect patient satisfaction. The objective was to evaluate aesthetics and satisfaction outcomes in four different incisions. We evaluated 176 incisions in 148 patients. The incisions performed were the original modified (16, group I), straight and shortened, (64, group II), "Z" shaped (16, group III), and oblique inguinal (48, group IV). The scars were evaluated for width and length, development of a hypertrophic scar, depression or hyperpigmentation, and dehiscence and resuture. A scale of satisfaction was applied (points ranging from 1 to 10). The Bartlett test and Kruskal-Wallis test were used. The mean width and length of the scars were 20.3 and 6.8 cm for group I, 6.5 and 8.1 for group II, 12.1 and 7.1 cm for group III, 13 and 1.4 cm for group IV, respectively. Hypertrophic scars were found in 18% in group I, 12.5% in group II, and 31.2% in group III. Depressed scars were found in 10.8% in group I and 7.1% in group II. Hyperpigmentation was found in 16% in groups I and II, 37% in group III, and 2% in group IV. Dehiscence was found in 8.1% in group I and 8.9% in group II. Satisfaction for group IV was nine points. The difference in length and width and satisfaction were statistically significant (P < 0.05). The oblique inguinal incision (group IV) showed a smaller percentage of complications, with an adequate aesthetic result, and a high grade of patient's satisfaction.

Surgical Anatomy of Bernese Periacetabular Osteotomy Modified Approach. A Cadaveric Study

Surgical Anatomy of Bernese Periacetabular Osteotomy Modified Approach. A Cadaveric Study

Acetabular dysplasia: a comparison of periacetabular osteotomy results of patients older and younger than 35 years.

Patient age has been reported to be an important determinant of treatment success in developmental dysplasia of the hip (DDH). This study aimed to determine the efficacy of periacetabular osteotomy (PAO) in DDH patients aged ≥ 35 years and to compare patient-reported and radiological outcomes with a control cohort of younger patients. This retrospective analysis included 43 patients (23 aged < 35 years; 20 aged ≥ 35 years) who underwent unilateral Bernese PAO for symptomatic DDH, between May 2001 and August 2015. Patients with a history of ipsilateral pelvic osteotomy or other pelvic pathologies were excluded. To evaluate the morphology of the dysplastic hip joints, 11 conventional radiographic measures were taken. Preoperative and postoperative Harris Hip Scores, postoperative visual analogue scale scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and hip range of motion measurements were used for clinical evaluation. Of the 43 patients, 31 (72.1%) were women and 14 (27.9%) were men. The average age was 32 (range: 19-45) years. Regarding sex, surgery site, mean body mass index and mean follow-up time, there were no significant differences between the groups. Both groups showed significant differences in radiographic parameters before and after the PAO. There were no significant differences in preoperative or postoperative clinical outcomes between the groups, except for the WOMAC score. PAO can be performed safely to treat acetabular dysplasia in patients aged ≥ 35 years, before the onset of femoroacetabular osteoarthritis, with satisfactory clinical and functional outcomes.