Anterior Femoroacetabular Impingement After Periacetabular Osteotomy

Background The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches. Questions/purposes The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach. Methods A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13-44 months). Results Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21-29; p \ 0.0001) and control groups (mean improvement, 21; 95% CI, 17-25; p \ 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, À1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center-edge angle (p = 0.4463), anterior center-edge angle (p = 0.0936), and Tönnis angle (p = 0.7953) improvement when compared with the classic approach. Conclusions The rectus-preserving approach for PAO is as safe and effective as the classic approach to achieve radiographic correction and HHS improvement at minimum 1 year. Additional investigation is needed to determine whether the rectus-preserving approach allows for improvement in functional recovery including hip flexion strength.

Section: Discussionmentioning

confidence: 99%

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

“…Myers et al [34] noted that excessive lateral and anterior correction in the PAO might lead to the femoroacetabular impingement (FAI), which induced residual pain and limited ROM. Peters et al [45] concluded that recognition of the true preoperative acetabular version and reorientation of the acetabulum into an appropriately anteverted position have become important factors in surgical decisionmaking.…”

Section: Discussionmentioning

confidence: 99%

Patient Selection Criteria for Periacetabular Osteotomy or Rotational Acetabular Osteotomy

Yasunaga

Yamasaki

Ochi

2012

Background Hip dysplasia is the most common cause of secondary osteoarthritis (OA). Periacetabular osteotomy (PAO) or rotational acetabular osteotomy (RAO) has been used as a joint-preserving procedure. However, the patient selection criteria are not clearly defined. Questions/purposes Based on a systematic review, we identified reported patient selection criteria for PAO or RAO. Methods We performed a systematic review of RAO and 18 studies met our inclusion criteria. For the PAO, the systemic review performed by Clohisy et al. was used. Where Are We Now? For patients with symptomatic hip dysplasia, lateral center-edge angle less than 10°to 30°, radiographic pre-or early OA, mean age at the time of surgery of 18 to 45 years, and improvement in joint congruency on AP radiograph with hip abduction, radiographic deformity correction consistently improved hip function in all studies. Radiographic OA progression was noted in 5% to 33% at 3.2 to 20 years postoperatively. Clinical score and prevention of radiographic OA progression of patients 50 years or older or with advanced stage were worse in younger patients or those with early stage. Where Do We Need to Go? The key challenges are (1) preoperative evaluation of articular cartilage; (2) indication for older patients; (3) prevention of secondary femoroacetabular impingement; and (4) intraarticular treatment combined with PAO or RAO. How Do We Get There? Future prospective, longitudinal cohort studies need to determine optimal patient selection criteria, risk factors for clinical failure, optimal deformity correction parameters, and the role of adjunctive surgical procedures.

“…Acetabular fixation was performed with three to five 4.5-mm screws. The overall goals of the surgical procedure were to correct the structural instability of the joint, optimize congruency, avoid overcorrection, and prevent secondary femoroacetabular impingement [22]. Secondary goals included optimizing abductor efficiency (trochanteric height) and leg lengths.…”

Section: Methodsmentioning

confidence: 99%

Combined Periacetabular and Femoral Osteotomies for Severe Hip Deformities

Clohisy

John

Nunley

et al. 2009

Periacetabular osteotomy (PAO) is an effective acetabular reorientation technique for treatment of symptomatic acetabular dysplasia. In hips with severe deformities, an adjunctive femoral osteotomy (PFO) may optimize correction, joint stability, and congruency. We analyzed the clinical and radiographic results of combined PAO/PFO in treating severe hip deformities. Second, we compared the clinical results of patients treated with PAO/ PFO with patients treated with isolated PAO for lesser deformities. Twenty-five patients (28 hips) treated with PAO/PFO were reviewed and followed a minimum of 16 months (mean, 44 months). The matched PAO cohort included 25 patients (28 hips). For the PAO/PFO group, the average Harris hip score improved from 60.9 to 86.3. Eighty-nine percent of the patients demonstrated at least a 10-point improvement in the hip score and 75% had a Harris hip score over 80 points. Radiographic evaluation demonstrated consistent deformity correction. The PAO/ PFO group had a lower average Harris hip score preoperatively, yet hip function after surgery was comparable between groups. These data indicate combined PAO/ PFO is associated with improved hip function in most patients. These clinical results are comparable to those obtained with isolated PAO for lesser hip deformities.