Concomitant Hip Arthroscopy and Periacetabular Osteotomy

Domb, Benjamin G.; LaReau, Justin M.; Hammarstedt, Jon E.; Gupta, Alka; Stake, Christine E.; Redmond, John M.

doi:10.1016/j.arthro.2015.06.002

Cited by 69 publications

(60 citation statements)

References 28 publications

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“…These 72 minutes included an arthroscopic examination of the joint with possible labral repair with or without chondroplasty and/or ligamentum teres debridement. This is similar to the study by Domb et al, 28 which showed the mean time for hip arthroscopy in their series of 17 patients was 59 minutes. The mean operative time for PAO alone in our series was 179 minutes compared with 300 minutes in the study by Domb et al…”

Section: Discussionsupporting

confidence: 80%

“…However, in their study, the arthroscopy was done without the use of fluid for joint distention or the use of a traction table for joint distraction. The patients in our study were treated in a similar to fashion to those treated by Domb et al 28 Patients were treated with supine arthroscopy with the use of traction to treat central compartment pathology. In contrast, our patients were maintained on the traction table and the PAO was performed without the need to transfer the patient to a new table.…”

Section: Discussionmentioning

confidence: 99%

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Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

Olson¹,

Neumann²,

Rickert³

et al. 2017

The Duke Orthopaedic Journal

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Purpose: To evaluate the safety of hip arthroscopy combined with a periacetabular osteotomy (PAO) compared with PAO alone in treating concomitant intra-articular pathology in hip dysplasia. Materials and methods:Forty-one patients (46 hips) with symptomatic hip dysplasia were retrospectively reviewed. Pre-and postoperative radiographic data and intraoperative data consisting of estimated blood loss, intraoperative and postoperative blood transfusions, operative time, and length of hospital stay were recorded. The complications occurring within the first 3 months after surgery including lateral femoral cutaneous and pudendal nerve neuropraxia, wound complications, and reoperations were recorded. Additionally, rates of deep venous thrombosis and other major adverse outcomes (myocardial infarction, pulmonary embolism, stroke, death) were examined.Results: Twenty-one patients (24 hips) underwent PAO alone. Twenty patients (22 hips) underwent hip arthroscopy followed immediately by PAO. There were no significant differences in the 90-day complication rates between the two groups, comparing the rate of neuropraxia (p = 0.155) and wound complications (p = 0.6). Operative time for PAO alone was 179 minutes (standard deviation [SD] ± 37) compared with 251 minutes (SD ± 52) for combined hip arthroscopy and PAO (p < 0.001). No incidence of deep vein thrombosis or major adverse events was noted in either group. Preoperative lateral center edge angle (LCEA) and acetabular index (AI) were 14° and 20° respectively, in the PAO-alone group and 19° and 16° respectively, in the combined group. Postoperatively, LCEA was 29° in the PAOalone group and 30° in the combined group. Postoperative AI was 11° in the PAO-alone group and 5° in the combined group. Conclusion:This study demonstrates that hip arthroscopy in combination with PAO to treat intra-articular pathology shows no difference in 90-day complication rates when compared with PAO alone.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

Olson¹,

Neumann²,

Rickert³

et al. 2017

The Duke Orthopaedic Journal

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“…75 A retrospective review of patients who underwent concomitant hip arthroscopy and PAO demonstrated all patients to have chondrolabral pathology at the time of PAO, with 71% (12 patients) undergoing labral repair. 76 In this study, all patients showed satisfactory mean clinical improvement, with no additional complications due to arthroscopy. Treatment of intra-articular pathology at the time of PAO has potential to improve outcomes, although this is still debated.…”

Section: Periacetabular Osteotomysupporting

confidence: 53%

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

et al. 2018

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Pain and debilitating symptoms due to hip osteoarthritis (OA) can significantly compromise quality of life in young, active patients. The management of the young adult with hip OA presents a unique set of challenges, with symptoms that originate from a variety of underlying hip pathologies, and patient age spanning from youth through middle age. Early options for hip OA include nonoperative treatment with anti-inflammatory medications, physical therapy, and injections. For patients with structural hip abnormalities (femoroacetabular impingement or dysplasia), arthroscopy or reconstructive osteotomy are acceptable treatment options. In advanced disease, joint-preserving techniques are often ineffective, and patients may require joint resurfacing or replacement. The treatment strategies for early hip OA continues to evolve with the development of new and refined surgical techniques, especially in the setting of underlying hip pathology, and a growing popularity of utilizing biologic agents. The purpose of this manuscript is to review current conservative and surgical management and to describe an algorithm for treatment of early-onset hip OA.

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“…Although different blood-conserving strategies, including the use of predonated autologous blood, cell saver autotransfusion, and tranexamic acid, have been described to avoid allogeneic transfusion, there is no universally accepted protocol to manage blood loss associated with periacetabular osteotomy. 5,9,14,15 Periacetabular osteotomy increasingly has been performed with arthrotomy 11,13 or in combination with hip arthroscopy 12,21,22 because of evidence that femoroacetabular impingement adversely affects the outcome of periacetabular osteotomy [23][24][25] and because of the high prevalence of intra-articular pathology. 10,11 Findings on predictive factors associated with blood loss during periacetabular osteotomy are limited and conflicting, and this study was conducted to determine patient and procedure risk factors related to blood loss in a cohort of 41 young patients undergoing periacetabular osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Factors That Predict Blood Loss After Bernese Periacetabular Osteotomy

Novais¹,

Carry²,

Kestel³

et al. 2016

Orthopedics

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Although strategies to reduce bleeding and avoid allogeneic transfusion have been described, there is controversy about the factors associated with blood loss after Bernese periacetabular osteotomy. This study was conducted to determine risk factors for postoperative blood loss. After institutional review board approval was obtained, a retrospective review was conducted of 41 young patients who underwent periacetabular osteotomy for symptomatic acetabular dysplasia over a 3-year period. Of these patients, two-thirds donated blood before surgery. A Cell Saver Elite autotransfusion system (Haemonetics, Braintree, Massachusetts) was used intraoperatively in all cases. Hemoglobin and hematocrit were obtained before surgery and during the hospital stay. The primary outcome variable was the percentage of total blood volume lost during surgery. Univariate analysis was performed to test the association between potential predictors of blood volume loss. Candidate variables that were significant at alpha=0.15 were tested with multivariate analysis. The average percentage of blood volume lost during surgery was 30.3% (95% confidence interval, 25.1%-35.5%). Univariate analysis showed that operative time, arthrotomy, femoral head-neck osteochondroplasty, labral procedure, male sex, and age were prognostic factors associated with increased blood volume loss. However, operative time (average, 294.6 minutes; range, 204-444 minutes) was the only independent predictor of increased blood loss in the final model. Additional procedures, such as femoral head-neck osteochondroplasty and labral repair or debridement performed through an anterior hip arthrotomy at the time of periacetabular osteotomy, were associated with increased operative time. The findings suggest that all patients undergoing periacetabular osteotomy, including those having concomitant procedures, may benefit from pre- and intraoperative strategies to conserve blood and avoid allogeneic transfusion. [Orthopedics. 2016; 39(6):e1147-e1153.].

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Concomitant Hip Arthroscopy and Periacetabular Osteotomy

Cited by 69 publications

References 28 publications

Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

Factors That Predict Blood Loss After Bernese Periacetabular Osteotomy

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