Endoscopy-assisted periacetabular osteotomy: a preliminary cadaveric study.
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ABSTRACT:
SUBMITTER: Inan M
PROVIDER: S-EPMC2504656 | biostudies-other | 2008 Apr
REPOSITORIES: biostudies-other
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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.
| S-EPMC4912685 | biostudies-literature
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.
| S-EPMC2505263 | biostudies-other
Project description:Background and purpose - Few studies have evaluated the long- and mid-term outcomes after minimally invasive periacetabular osteotomy (PAO). We investigated: (1) the long-term hip survival rate after PAO; (2) the risk of complications and additional surgery after PAO; and (3) the hip function at different follow-up points.Patients and methods - We reviewed 1,385 hips (1,126 patients) who underwent PAO between January 2004 and December 2017. Through inquiry to the Danish National Patient Registry we identified conversions to total hip arthroplasty (THA) and complications after PAO. We evaluated the Hip disability and Osteoarthritis Outcome Score (HOOS) obtained preoperatively, and at 6 months, 2-, 5-, and 10-years' follow-up.Results - 73 of the 1,385 hips were converted to THA. The overall Kaplan-Meier hip survival rate was 80% (95% CI 68-88) at 14 years with a mean follow-up of 5 years (0.03-14). 1.1% of the hips had a complication requiring surgical intervention. The most common additional surgery was removal of screws (13%) and 11% received a hip arthroscopy. At the 2-year follow-up, HOOS pain improved by a mean of 26 points (CI 24-28) and a HOOS pain score > 50 was observed in 86%.Interpretation - PAO preserved 4 of 5 hips at 14 years, with higher age leading to lower survivorship. The PAO technique was shown to be safe; 1.1% of patients had a complication that demanded surgical intervention. The majority of the patients with preserved hips have no or low pain. The operation is effective with a good clinical outcome.
| S-EPMC8023930 | biostudies-literature
Project description:Individuals with hip dysplasia report significant functional disability that improves with periacetabular osteotomy (PAO). Four physical performance measures (PPMs) have been recently validated for use with nonarthritic hip conditions; however, their ability to detect functional improvement and correlate with improvements in popular hip-specific patient-reported outcome (PRO) instruments after PAO is unknown. The purpose of this study was to evaluate the responsiveness of four PPMs up to 1 year after PAO, compare PPMs with established PRO measures at these time points, and report the acceptability and utility of PPMs for assessing outcomes after PAO. Twenty-two participants aged 15 to 39 years completed the timed stair ascent (TSA), sit-to-stand five times (STS5), self-selected walking speed, four-square-step test, and seven hip-specific PRO measures before surgery and at approximately 6 months and 1 year after PAO. They completed questions regarding acceptability and utility of both types of testing. Wilcoxon rank sum test and unpaired Student t-tests were used to assess differences between time points; Spearman correlation and generalized linear modeling were used to determine the relationship between PPMs and PRO measures. Six months after PAO, participants showed significant improvements on all seven PRO instruments (P < 0.001) and on the STS5 (P = 0.01). At one year, these improvements were maintained and TSA also improved (P = 0.03). Improvement in other PPMs did not reach significance (P = 0.07 and 0.08). The STS5 test demonstrated moderate to strong correlation (|r| = 0.43 to 0.76, P < 0.05) with all PRO measures, and the TSA test demonstrated moderate to strong correlation with almost all measures (|r| = 0.43 to 0.58, P < 0.05). Correlations strengthened on subanalysis of participants with unilateral disease (n = 11) (|r| = 0.56 to 0.94, P < 0.05). All participants (100%) found PPM testing acceptable despite disability; 25% preferred PPMs to PRO measures, whereas 75% of participants found them equal in usefulness. The STS5 and TSA tests demonstrated moderate to very strong correlation with PRO measures at six and 12 months after PAO for dysplasia. These tests could be used as a functional outcome to supplement PRO instruments after PAO.
| S-EPMC8189615 | biostudies-literature
Project description:Background Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO. Methods A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO. Results The pre- and post-operative sports activity participation rates were 55.8 and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier. Conclusions Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.
| S-EPMC7520950 | biostudies-literature
Project description:During the last years, multiple methods and a wide set of materials for skull base reconstruction have been described. In our experience, the ideal graft for duraplasty is the iliotibial tract due to its favorable characteristics in terms of thickness, pliability, and strength. In this report, we show the iliotibial tract-harvesting technique under endoscopic guidance with a minimally invasive approach using a cadaveric model. Two longitudinal incisions of 1 cm each were made at 4 cm down a line drawn between the anterior-superior iliac spine and the lateral margin of patella at the extremities of the middle third of the thigh. By using a set of instruments for endoscopic face-lifting, the graft was easily set up and harvested. The endoscopic approach is associated with less visible scars, but longer operative time in comparison with open traditional procedure. The pros and cons in terms of morbidity need to be evaluated by further studies on actual cases.
| S-EPMC3312104 | biostudies-other
Project description:OBJECTIVE:State-of-the-art navigation systems for pelvic osteotomies use optical systems with external fiducials. In this paper, we propose the use of X-ray navigation for pose estimation of periacetabular fragments without fiducials. METHODS:A two-dimensional/three-dimensional (2-D/3-D) registration pipeline was developed to recover fragment pose. This pipeline was tested through an extensive simulation study and six cadaveric surgeries. Using osteotomy boundaries in the fluoroscopic images, the preoperative plan was refined to more accurately match the intraoperative shape. RESULTS:In simulation, average fragment pose errors were 1.3 ° /1.7 mm when the planned fragment matched the intraoperative fragment, 2.2 ° /2.1 mm when the plan was not updated to match the true shape, and 1.9 ° /2.0 mm when the fragment shape was intraoperatively estimated. In cadaver experiments, the average pose errors were 2.2 ° /2.2 mm, 3.8 ° /2.5 mm, and 3.5 ° /2.2 mm when registering with the actual fragment shape, a preoperative plan, and an intraoperatively refined plan, respectively. Average errors of the lateral center edge angle were less than 2 ° for all fragment shapes in simulation and cadaver experiments. CONCLUSION:The proposed pipeline is capable of accurately reporting femoral head coverage within a range clinically identified for long-term joint survivability. SIGNIFICANCE:Human interpretation of fragment pose is challenging and usually restricted to rotation about a single anatomical axis. The proposed pipeline provides an intraoperative estimate of rigid pose with respect to all anatomical axes, is compatible with minimally invasive incisions, and has no dependence on external fiducials.
| S-EPMC7297497 | biostudies-literature
Project description:In the setting of true hip dysplasia, the high prevalence of intra-articular pathology may lead to recurrent symptoms and failure after periacetabular osteotomy (PAO). Femoral neck osteochondroplasty, microfracture, removal of loose bodies, and labral repair are examples of procedures that are performed with concomitant arthroscopy. When damage to the labrum is too severe to repair, reconstruction instead of extensive debridement before PAO can be more effective in restoring the labral seal to maintain joint lubrication and chondral protection. This Technical Note describes a method for concomitant hip arthroscopy with circumferential labral reconstruction with allograft and PAO.
| S-EPMC6262138 | biostudies-literature
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.
| S-EPMC4017955 | biostudies-literature
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.
| S-EPMC5063177 | biostudies-literature