Periacetabular osteotomy

Pogliacomi, Francesco; Stark, André; Wallensten, Richard

doi:10.1080/00016470510030346

Cited by 45 publications

(3 citation statements)

References 32 publications

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“…The issue of VTE after pelvic and/or femoral osteotomy has been evaluated previously. The incidence of VTE in patients undergoing PAO has been reported to be very low at 0% to 5% [541][542][543][544][545][546] . Although the incidence of VTE after osteotomy seems to be lower than that after total joint arthroplasty without prophylaxis, these values are not negligible and VTE prophylaxis should still be considered.…”

Section: Arielmentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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Section: Arielmentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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“…Van BerGayk et al included 22 patients, reporting significant improvement in pain and function 24 months after PAO within both the WOMAC and the SF-36 scores, although not in the SF-36 mental component score[ 12 ]. Several studies with a retrospective design all showed a significant drop in pain and an increase in the activity component of their patient-reported outcomes [ 10 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

What level of pain reduction can be expected up to two years after periacetabular osteotomy? A prospective cohort study of 146 patients

Jakobsen

Mechlenburg

Søballé

et al. 2018

Journal of Hip Preservation Surgery

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Periacetabular osteotomy (PAO) corrects underlying anatomical anomalies, reduces pain and may postpone or even prevent osteoarthritis onset in patients with symptomatic acetabular dysplasia. Current evidence is based on immediate post-operative pain levels, but knowledge on pain levels in the period after PAO is scarce, and the association between pain score and acetabular angles at PAO is unknown. This study had two aims. First, we studied pain level and patient-reported outcome scores pre- and postoperatively; second, we analysed the association between acetabular angles and pain level. From our database, 426 patients operated from June 2012 to November 2015 were analysed; 127 were excluded. Patients were invited to complete standardized questionnaires preoperatively and postoperatively at 6 and 24 months. Pain was measured using visual analogue scale (VAS). Multiple regression analysis was used to investigate the association between change in centre edge (CE) and acetabular index (AI) angle and pre/postoperative pain levels. Mean (standard deviation, SD) VAS pain at rest before surgery and at the 6- and 24-month follow-up were 35 (24), 14 (20) and 14 (19), respectively. Mean (SD) VAS pain at activity were 69 (22), 41 (29) and 41 (30), respectively. Both VAS pain at rest and at activity fell from the preoperative level to 6 months post-surgery with no further change at 24 months. Patients reported significant improvement in outcomes after 6 months and no further change at the 24-month follow-up. There was no significant association between change in CE/AI angles and VAS pain, either during rest or activity.

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“…Reconstructive osteotomies aim to restore normal hip anatomy and are subdivided into three groups: acetabuloplasty with distal mobilization of the acetabular roof (Pemberton, Albee-Lance, Dega, San Diego), redirectional osteotomies involving the displacement of pelvic fragments (Salter, Le Coeur, Hopf, Steel, Sutherland-Greenfield, Kalamchi, Tönnis-Trousseau, PemberSal), and pelvic osteotomies with the reorientation of the acetabulum (Blavier, Wagner, Eppright, Ninomiya, Hsieh, Ganz-Bernese). Salvage osteotomies, recommended post-bone maturity, aim to postpone arthroplasty and provide enhanced coverage of the acetabular component during arthroplasty (Chiari, Wilson, Staheli) [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of Various Osteotomies Used in the Treatment of Developmental Hip Dysplasia in Children

Incze-Bartha,

Simon-Szabó

et al. 2024

JPM

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Late-discovered developmental hip dysplasia deformities often necessitate complex surgical treatments and meticulous preoperative planning. The selection of osteotomies is contingent upon the patient’s age and the specific structural deformity of the hip. In our anatomical hip model, derived from the data of a 12-year-old patient, we performed virtual osteotomies that are commonly recommended for such cases. We precisely constructed geometric models for various osteotomies, including the Dega, Pemberton, Tönnis, Ganz, Chiari pelvic, and Pauwels femoral osteotomies. We employed Autodesk Inventor for the finite element analysis of the hip joint and the corrective osteotomies. In comparing one-stage osteotomies, we noted that the Dega and Ganz pelvic osteotomies, especially when combined with the Pauwels femoral osteotomy, yielded the most favorable outcomes. These combinations led to enhanced femoral head coverage and reduced intra-articular pressure. Furthermore, we calculated the femoral head-to-acetabulum volume ratio for both the Dega and Pauwels osteotomies. The encouraging results we obtained advocate for the integration of finite element analysis in virtual osteotomies of the pelvis and femur as a preoperative tool in the management of developmental hip dysplasia.

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Periacetabular osteotomy

Cited by 45 publications

References 32 publications

Recommendations from the ICM-VTE: Hip & Knee

Recommendations from the ICM-VTE: Hip & Knee

What level of pain reduction can be expected up to two years after periacetabular osteotomy? A prospective cohort study of 146 patients

Finite Element Analysis of Various Osteotomies Used in the Treatment of Developmental Hip Dysplasia in Children

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