Midterm Outcomes of Reverse (Anteverting) Periacetabular Osteotomy in Patients With Hip Impingement Secondary to Acetabular Retroversion

Parry, Joshua A.; Swann, Russell P.; Erickson, Jill; Peters, Christopher L.; Trousdale, Robert T.; Sierra, Rafael J.

doi:10.1177/0363546515620382

Cited by 47 publications

(40 citation statements)

References 22 publications

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“…Although anterolateral coverage increased, anteromedial coverage decreased, and thus, it remains unclear if PAO is efficacious at preventing anterior hip impingement. Collectively, these results suggest that successful outcomes following PAO in retroverted hips may be due to a reduction in loads and stresses at the labrum and improved posterior coverage, and not the result of improved cartilage contact mechanics.…”

Section: Discussionmentioning

confidence: 83%

Changes in chondrolabral mechanics, coverage, and congruency following peri‐acetabular osteotomy for treatment of acetabular retroversion: A patient‐specific finite element study

Knight

Abraham

Peters

et al. 2017

Journal Orthopaedic Research

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Using a validated finite element (FE) protocol, we quantified cartilage and labrum mechanics, congruency, and femoral coverage in five male patients before and after they were treated for acetabular retroversion with peri-acetabular osteotomy (PAO). Three-dimensional models of bone, cartilage, and labrum were generated from computed tomography (CT) arthrography images, acquired before and after PAO. Walking, stair-ascent, stair-descent, and rising from a chair were simulated. Cartilage and labrum contact stress, contact area, and femoral coverage were calculated overall and regionally. Mean congruency (average of local congruency values for FE nodes in contact) and peak congruency (most incongruent node in contact) were calculated overall and regionally. Load supported by the labrum was represented as a raw change in the ratio of the applied force transferred through the labrum and percent change following surgery (calculated overall only). Considering all activities, following PAO, mean acetabular cartilage contact stress increased medially, superiorly and posteriorly; peak stress increased medially and posteriorly. Peak labrum stresses decreased overall and superiorly. Acetabular contact area decreased overall and laterally, and increased medially. Labral contact area decreased overall, but not regionally. Load to the labrum decreased. Femoral head coverage increased overall, anterolaterally, and posterolaterally, but decreased anteromedially. Mean congruency indicated the hip became less congruent overall, anteriorly, and posteriorly; peak congruency indicated a less congruent joint posteriorly. Clinical Relevance Medialization of contact and reductions in labral loading following PAO may prevent osteoarthritis, but this procedure increases cartilage stresses, decreases contact area, and makes the hip less congruent, which may overload cartilage.

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Section: Discussionmentioning

confidence: 83%

Changes in chondrolabral mechanics, coverage, and congruency following peri‐acetabular osteotomy for treatment of acetabular retroversion: A patient‐specific finite element study

Knight

Abraham

Peters

et al. 2017

Journal Orthopaedic Research

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“…It can be treated by anteverting PAO (Fig. 5A-C) [31,40,41,48] or acetabular rim trimming [2,7,13,29,42] with refixation of the labrum (Fig. 6A-C).…”

Section: Discussionmentioning

confidence: 99%

“…These have consisted of localized débridement or removal of the anterior acetabular rim via either open or arthroscopic techniques [29,30,33,34,43,57] or by reorientation of the entire acetabulum by periacetabular osteotomy (PAO) resulting in anteversion [31,39,40]. At shortterm followup (defined as 2-4 years), both surgical treatments have demonstrated substantial improvements in clinical scores without radiographic progression of osteoarthritis [29-31, 33, 34, 39, 40, 43].…”

Section: Introductionmentioning

confidence: 99%

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Zurmühle

Anwander

Albers

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Acetabular retroversion can cause impaction-type femoroacetabular impingement leading to hip pain and osteoarthritis. It can be treated by anteverting periacetabular osteotomy (PAO) or acetabular rim trimming with refixation of the labrum. There is increasing evidence that acetabular retroversion is a rotational abnormality of the entire hemipelvis and not a focal overgrowth of the anterior acetabular wall, which favors an anteverting PAO. However, it is unknown if this larger procedure would be beneficial in terms of survivorship and Merle d'Aubigné scores in a midterm followup compared with rim trimming. Questions/purposes We asked if anteverting PAO results in increased survivorship of the hip compared with rim trimming through a surgical hip dislocation in patients with symptomatic acetabular retroversion. Methods We performed a retrospective, comparative study evaluating the midterm survivorship of two matched patient groups with symptomatic acetabular retroversion undergoing either anteverting PAO or acetabular rim trimming through a surgical hip dislocation. Acetabular retroversion was defined by a concomitantly present positive crossover, posterior wall, and ischial spine sign. A total of 279 hips underwent a surgical intervention for acetabular retroversion at our center between 1997 and 2012 (166 periacetabular osteotomies, 113 rim trimmings through surgical hip dislocation). A total of 99 patients (60%) were excluded from the PAO group and 56 patients (50%) from the rim trimming group because they had any of several prespecified conditions (eg, dysplasia . A minimum followup of 2 years was required for this study. Failures were included at any time. The median followup for the anteverting PAO group was 9.5 years (range, 2-17.4 years) and 6.8 years (range, 2.2-10.5 years) for the rim trimming group (p \ 0.001). Kaplan-Meier survivorship analysis was performed using the following endpoints at 5 and 10 years: THA, radiographic One author (MT) has received funding from the Swiss National Science Foundation (SNSF). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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“…38 Another series with a mean follow-up of 5 years, showed an improvement in the average Harris hip score from 58 to 93, and the need for reoperation in 13% of the cases. 39 Complications are similar to those already described for conventional PAO, hematoma, infection, paralysis or nerve injury, heterotopic ossification, and need for implant removal. 40…”

Section: Periacetabular Osteotomy Reversementioning

confidence: 54%

Impacto femoroacetabular e lesão do lábio acetabular – Parte 3: Tratamento cirúrgico

Queiroz

Junior

Ejnisman

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoNos últimos 15 anos, o diagnóstico do impacto femoroacetabular tem se tornado cada vez mais frequente; com o avanço do entendimento de quais pacientes potencialmente se beneficiariam do tratamento cirúrgico, diferentes técnicas foram desenvolvidas. O tratamento cirúrgico inclui grande variedade de opções, sendo elas: osteotomia periacetabular, técnica de luxação cirúrgica do quadril, artroscopia com osteocondroplastia via pequena incisão, técnica via anterior modificada, e técnica exclusivamente artroscópica. O tipo de abordagem deve ser escolhido de acordo com a complexidade da morfologia do impacto femoroacetabular e com o treinamento do cirurgião. As técnicas mais utilizadas atualmente são a artroscopia, a luxação cirúrgica do quadril e a osteotomia periacetabular. O presente artigo busca descrever as principais técnicas cirúrgicas utilizadas para o tratamento do impacto femoroacetabular, suas indicações, vantagens e desvantagens, complicações e resultados clínicos.

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Midterm Outcomes of Reverse (Anteverting) Periacetabular Osteotomy in Patients With Hip Impingement Secondary to Acetabular Retroversion

Abstract: RPAO performed for FAI in the young patient with isolated acetabular retroversion or retroversion in the setting of dysplasia successfully improved clinical and radiographic results at mid- to long-term follow-up.

Cited by 47 publications

References 22 publications

Changes in chondrolabral mechanics, coverage, and congruency following peri‐acetabular osteotomy for treatment of acetabular retroversion: A patient‐specific finite element study

Changes in chondrolabral mechanics, coverage, and congruency following peri‐acetabular osteotomy for treatment of acetabular retroversion: A patient‐specific finite element study

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Impacto femoroacetabular e lesão do lábio acetabular – Parte 3: Tratamento cirúrgico

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