Fracture at the Ischio-Pubic Junction After Periacetabular Osteotomy in the Adolescent Population

Swann, Matthew; Sucato, Daniel J.; Roméro, J.; Podeszwa, David A.

doi:10.1097/bpo.0000000000000742

Cited by 5 publications

(11 citation statements)

References 19 publications

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“…40 However, they can be associated with significant morbidity such as extended operative times, increased blood loss, prolonged rehabilitation, fractures, and possibility of inducing femoroacetabular impingement (FAI). 1,19,26,41 There is also the potential for major complications such as sciatic nerve palsy and inaccurate or loss of fragment orientation. 42,45 Hip arthroscopic surgery as a primary modality in treating patients with hip dysplasia is controversial because of the concern that despite addressing the intra-articular abnormalities, it may not adequately correct the underlying bony abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes

et al. 2017

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While periacetabular osteotomy remains the standard for treating true acetabular dysplasia, hip arthroscopy may provide a safe and durable means of managing intra-articular abnormalities in the setting of borderline acetabular dysplasia at midterm follow-up. These procedures should be performed by surgeons with expertise in advanced arthroscopic techniques, using strict patient selection criteria, with emphasis on labral preservation and capsular plication.

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Section: Discussionmentioning

confidence: 99%

Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes

et al. 2017

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“…Fractures of the inferior pubic ramus (Figure 3) were indicated by the radiolucency or discontinuity at the ischial/inferior pubic ramus or at the ischiopubic junction (IPJ). 16,21 Union of the osteotomies was confirmed on AP radiological view of the pelvis on 12-month follow-up after surgery. Osseous union was confirmed if there was no visible radiolucent line and an uninterrupted trabecular pattern.…”

Section: Methodsmentioning

confidence: 80%

“…Fractures of the inferior pubic ramus (Figure 3) were indicated by the radiolucency or discontinuity at the ischial/inferior pubic ramus or at the ischiopubic junction (IPJ). 16,21…”

Section: Methodsmentioning

confidence: 99%

“…Numerous studies have reported favourable outcomes both at intermediate and longer-term follow-up, in cases of dysplasia and/or acetabular retroversion. [1][2][3][4][5][6] A variety of complications associated with this technically demanding procedure have been reported over the last 30 years, following its original description by Ganz et al [7][8][9][10][11][12] Stress fractures of the ischium or pubis have also been reported following PAO, 10,[13][14][15][16][17] however there is limited study of its incidence and contributing risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…13 Stress fractures generally present at the inferior ischiopubic junction, the inferior and superior pubic rami, and at the posterior column. [14][15][16] Although these reports provided early insight into this potential complication, the exact incidence of and risk factors for stress fracture have been difficult to define, given the paucity of literature on the subject and the absence of clear, standardized radiological protocols, including both anteroposterior (AP) and false profile radiographs to evaluate the pubic rami and posterior column.…”

Section: Introductionmentioning

confidence: 99%

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The incidence and risk factors for stress fracture following periacetabular osteotomy

Morris

Justo

Williams

et al. 2022

The Bone & Joint Journal

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Aims The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union. Methods We retrospectively reviewed all periacetabular osteotomies (PAOs) performed for developmental dysplasia of the hip (DDH) at one institution over a six-year period between 2012 and 2017. Perioperative factors were recorded, and included demographic and surgical data. Postoperatively, patients were followed for a minimum of one year with anteroposterior and false profile radiographs of the pelvis to monitor for evidence of stress fracture and union of osteotomies. We characterized the incidence and locations of stress fractures, and used univariate and multivariable analysis to identify factors predictive of stress fracture and the association of stress fracture on osteotomy union. Results A total of 331 patients underwent PAO during the study period with 56 (15.4%) stress fractures: 46 fractures of the retroacetabular posterior column, five cases of ischiopubic stress fracture, and five cases of concurrent ischiopubic and retroacetabular stress fractures. Overall, 86% (48/56) healed without intervention. Univariate analysis revealed that stress fractures occurred more frequently in females (p = 0.040), older patients (mean age 27.6 years (SD 8.4) vs 23.8 (SD 9.0); p = 0.003), and most often with the use of the broad Mast chisel (28.5%; p < 0.001). Multivariable analysis revealed that increasing age (odds ratio (OR) 1.04; 95% CI 1.01 to 1.07; p = 0.028) and use of the broad Mast chisel (OR 5.1 (95% CI 1.3 to 19.0) compared to narrow Ganz chisel; p = 0.038) and surgeon (p = 0.043) were associated with increased risk of stress fracture. Patients with stress fractures were less likely to have healed osteotomies after one-year follow-up (76% vs 96%; p < 0.001). Conclusion Stress fracture of the posterior column may be an under-recognized complication following PAO, and the rate may be influenced by surgical technique. Consideration should be given to using a narrow chisel during the ischial cut to reduce the risk of stress propagation through the posterior column. Cite this article: Bone Joint J 2022;104-B(9):1017–1024.

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Mechanical influence of periacetabular osteotomy on late total hip arthroplasty

Chen

2023

Numer Methods Biomed Eng

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Periacetabular osteotomy (PAO) is an effective technique to treat symptomatic hip dysplasia. However, following PAO, some patients still experience persistent pain or development of hip arthritis, requiring total hip arthroplasty (THA). Issues such as whether patients with PAO are necessarily at increased risk of post-THA complications and revision of the prosthesis remain debatable. The purpose of this study was to evaluate the biomechanical influence of PAO on the acetabulum after THA by finite element analysis. Eight patients with developmental dysplasia of the hip (DDH) diagnosed in the Fourth Medical Center of the PLA General Hospital were enrolled in this research. Patientspecific hip joint models were reconstructed from computed tomography scans,

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Fracture at the Ischio-Pubic Junction After Periacetabular Osteotomy in the Adolescent Population

Abstract: Level III.

Cited by 5 publications

References 19 publications

Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes

Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes

The incidence and risk factors for stress fracture following periacetabular osteotomy

Mechanical influence of periacetabular osteotomy on late total hip arthroplasty

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