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Reliable angle assessment during periacetabular osteotomy with a novel device.

ABSTRACT: We developed and assessed a measuring device for intraoperative assessment of the acetabular index and center edge angle during acetabular reorientation in periacetabular osteotomy. We asked whether reliable assessment of angles could be made using the device; to be reliable we presumed the variability of angle measurements should not exceed that of inherent variability when assessing angles on radiographs (+/- 5 degrees ). The device was mounted bilaterally on the pelvis, and using fluoroscopy, angle measurements were obtained with adjustable measuring discs. We conducted a cadaver study to assess intraobserver and interobserver variability of the device and to assess if pelvic positioning influenced variation of measurements. Intraoperative measurements of 35 consecutive patients were compared with measurements on postoperative radiographs. Intraoperatively obtained angle measurements differed less than +/- 5 degrees from measurements on postoperative radiographs and the intraobserver and interobserver variability of the device were confined within +/- 5 degrees . Positioning did not influence the variation of angle measurements beyond intraobserver variability of the device when applying arcs of tilt and rotation of +/- 12.5 degrees . We believe the device is a potentially helpful tool in the periacetabular osteotomy. It is simple to use and facilitates repeated reliable angle measurements during acetabular reorientation, making intraoperative radiographs unnecessary.

SUBMITTER: Troelsen A

PROVIDER: S-EPMC2311482 | biostudies-other | 2008 May

REPOSITORIES: biostudies-other

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Endoscopy-Assisted Periacetabular Osteotomy.

Project description:Minimizing soft tissue dissection and improving visualization of vital structures during periacetabular osteotomy (PAO) is of paramount importance to improve patient outcome and minimize complications. The endoscopy-assisted PAO was introduced to accomplish this objective. It involves an initial hip arthroscopy, for treatment of central compartment pathology, followed by a mini-open Bernese periacetabular osteotomy under fluoroscopic and endoscopic guidance, and completed by final dynamic hip arthroscopy to assess acetabular reorientation and fixation and to perform femoroplasty in relation to the new acetabular rim position, if needed. Endoscopy-assisted PAO is used to treat dysplasia or acetabular retroversion in a minimally invasive fashion.

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Technique for Intraoperative Neuromonitoring During Periacetabular Osteotomy After Concomitant Hip Arthroscopy.

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| S-EPMC7695750 | biostudies-literature

Extraarticular fractures after periacetabular osteotomy.

Project description:UNLABELLED: Extraarticular fractures of the pelvic ring after periacetabular osteotomy could impair stability of the acetabular fragment and cause poor clinical and radiographic outcomes. We evaluated 17 patients (17 hips) with fractures of either the ipsilateral os pubis (n = 12) or os ischium (n = 5) during the postoperative period after periacetabular osteotomy. Ischial fractures seemed more debilitating with two of five resulting in painful nonunions for which additional surgery was performed. In contrast, only one patient with pubic fracture had additional surgery. Ischial fractures took almost twice as long to achieve resolution of symptoms compared with pubic fractures, and when left untreated, asymptomatic nonunions developed in three of five. However, we observed no effect on acetabular fragment positioning or long-term clinical outcome. It is essential to be aware of this potential complication and realize it could be accompanied by substantial morbidity for patients during the rehabilitation period after periacetabular osteotomy, but does not seem to influence the longer-term outcome. LEVEL OF EVIDENCE: Level IV, therapeutic study.

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Pose Estimation of Periacetabular Osteotomy Fragments With Intraoperative X-Ray Navigation.

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Concomitant Arthroscopy With Labral Reconstruction and Periacetabular Osteotomy for Hip Dysplasia.

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Project description:Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are outlined.

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Efficiency and Accuracy of Bernese Periacetabular Osteotomy for Adult Hip Dysplasia.

Project description:Bernese periacetabular osteotomy (PAO) has several advantages dealing with adolescents and adults acetabular dysplasia. The authors introduced the details and steps performing PAO, with attached video and schematic diagram which demonstrates a perfect PAO in efficiency and accuracy. The patient is an 18-year-old girl, complaining hip pain on the left side for 6 months. Physical examination shows normal gait and range of motion (ROM) of the left hip. Pelvic anteroposterior X-ray shows acetabular dysplasia on the left, and post operation on the right. She is very satisfied with the PAO on the right one year before, so we recommend PAO for the left hip dysplasia again. The key point of PAO includes 4 cuts: ischial cut, pubic cut, acetabular roof cut, and quadrilateral bone cut, and the four cuts should be accomplished accurately. Then the acetabular fragment should be turned to ideal position with the lateral CE angle (LCE) > 25°, the Tönnis acetabular angle 0°, the anterior CE angle (ACE) > 20°, good congruence joint space, and with the hip center medialized slightly. At lastly the acetabular fragment is fixed with proper nails and instruments. The patient is very happy to the surgery with no hip pain, with normal gait, ROM, and Harris hip scores (HHS). In summary, PAO is a relative new and efficient procedure for adult hip dysplasia, requiring accurate techniques. Cadaveric practice and familiar with the local anatomy can help the surgeon overcome the learning curve quickly.

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Endoscopy-assisted periacetabular osteotomy: a preliminary cadaveric study.

Project description:Periacetabular osteotomy has been recommended for reconstructing symptomatic dysplastic hips in adolescents and young adults, but requires substantial incisions and exposure. To minimize large incisions, we asked whether periacetabular osteotomy could be performed with a mini-incision under direct endoscopic control. We used five fresh-frozen cadaver pelves and developed curved guides and osteotomes for the osteotomy. We were able to perform a periacetabular osteotomy under endoscopic and image intensifier control and to fix the osteotomy with two cannulated screws. We identified no damage to vital structures or intraarticular fracture in any of the five cadavers we subsequently dissected. We believe periacetabular osteotomy may be performed with a mini-incision under direct endoscopic control. Our preliminary observations suggest the approach might be explored in limited prospective clinical trials by experienced individuals.

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Mean 20-year followup of Bernese periacetabular osteotomy.

Project description:UNLABELLED: The goal of the Bernese periacetabular osteotomy is to correct the deficient acetabular coverage in hips with developmental dysplasia to prevent secondary osteoarthrosis. We determined the 20-year survivorship of symptomatic patients treated with this procedure, determined the clinical and radiographic outcomes of the surviving hips, and identified factors predicting poor outcome. We retrospectively evaluated the first 63 patients (75 hips) who underwent periacetabular osteotomy at the institution where this technique was developed. The mean age of the patients at surgery was 29 years (range, 13-56 years), and preoperatively 24% presented with advanced grades of osteoarthritis. Four patients (five hips) were lost to followup and one patient (two hips) died. The remaining 58 patients (68 hips) were followed for a minimum of 19 years (mean, 20.4 years; range, 19-23 years) and 41 hips (60%) were preserved at last followup. The overall mean Merle d'Aubigné and Postel score decreased in comparison to the 10-year value and was similar to the preoperative score. We observed no major changes in any of the radiographic parameters during the 20-year postoperative period except the osteoarthritis score. We identified six factors predicting poor outcome: age at surgery, preoperative Merle d'Aubigné and Postel score, positive anterior impingement test, limp, osteoarthrosis grade, and the postoperative extrusion index. Periacetabular osteotomy is an effective technique for treating symptomatic developmental dysplasia of the hip and can maintain the natural hip at least 19 years in selected patients. LEVEL OF EVIDENCE: Level III, prognostic study.

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