Ira Zaltz1, Geneva Baca2, Young-Jo Kim3, Perry Schoenecker4, Robert Trousdale5, Rafael Sierra5, Daniel Sucato6, Ernie Sink7, Paul Beaulé8, Michael B Millis3, David Podeszwa6, John C Clohisy2. 1. William Beaumont Hospital - Royal Oak, 30575 Woodward Avenue, Suite 100, Royal Oak, MI 48073. 2. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for J.C. Clohisy: clohisyj@wudosis.wustl.edu. 3. Department of Orthopaedic Surgery, Boston Children's Hospital, Hunnewell-2, 300 Longwood Avenue, Boston, MA 02115. 4. Shriner's Hospital, Medical Staff Office, 2001 South Lindberg Boulevard, St. Louis, MO 63131. 5. Mayo Clinic, 200 1st Street SW E14B, Rochester, MN 55905. 6. Texas Scottish Rite Hospital, 2222 Welborn Street, Dallas, TX 75219. 7. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. 8. Ottawa General Hospital, 501 Smyth Road, Suite 5004, Ottawa, ON K1H 8L6, Canada.
Abstract
BACKGROUND: The purpose of this prospective multicenter study was to determine and categorize all complications associated with the periacetabular osteotomy performed by experienced surgeons. METHODS: We prospectively analyzed perioperative complications in 205 consecutive unilateral periacetabular osteotomies performed at seven institutions by ten surgeons. All perioperative complications were recorded at an average of ten weeks and one year after surgery in standardized fashion using a validated complication grading scheme applied to hip preservation procedures. The mean patient age was 25.4 years. There were 143 female and sixty-two male patients. The most common diagnosis was developmental acetabular dysplasia, and concomitant procedures most commonly included femoral osteochondroplasty (58%) or hip arthroscopy (20%), which could include labral repair or resection. RESULTS: Major complications (grade III or IV) occurred in twelve patients (5.9%). Seven complications were evident at the ten-week visit and five at the one-year visit. Nine of the complications required a second surgical intervention, including repair for acetabular migration or implant adjustment (four patients), incision and drainage for a deep infection (two patients), and heterotopic bone resection, contralateral peroneal nerve decompression, and posterior column fixation (one patient each). Three thromboembolic complications were managed medically. There were no vascular injuries, permanent nerve palsies, intra-articular osteotomies and/or fractures, or acetabular osteonecrosis. The most common grade-I or II complication was asymptomatic heterotopic ossification. CONCLUSIONS: For surgeons experienced with the periacetabular osteotomy, it is a safe procedure but is associated with a 5.9% risk of grade-III or IV complications beyond the learning curve. The majority of these complications are resolved without permanent disability. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: The purpose of this prospective multicenter study was to determine and categorize all complications associated with the periacetabular osteotomy performed by experienced surgeons. METHODS: We prospectively analyzed perioperative complications in 205 consecutive unilateral periacetabular osteotomies performed at seven institutions by ten surgeons. All perioperative complications were recorded at an average of ten weeks and one year after surgery in standardized fashion using a validated complication grading scheme applied to hip preservation procedures. The mean patient age was 25.4 years. There were 143 female and sixty-two male patients. The most common diagnosis was developmental acetabular dysplasia, and concomitant procedures most commonly included femoral osteochondroplasty (58%) or hip arthroscopy (20%), which could include labral repair or resection. RESULTS: Major complications (grade III or IV) occurred in twelve patients (5.9%). Seven complications were evident at the ten-week visit and five at the one-year visit. Nine of the complications required a second surgical intervention, including repair for acetabular migration or implant adjustment (four patients), incision and drainage for a deep infection (two patients), and heterotopic bone resection, contralateral peroneal nerve decompression, and posterior column fixation (one patient each). Three thromboembolic complications were managed medically. There were no vascular injuries, permanent nerve palsies, intra-articular osteotomies and/or fractures, or acetabular osteonecrosis. The most common grade-I or II complication was asymptomatic heterotopic ossification. CONCLUSIONS: For surgeons experienced with the periacetabular osteotomy, it is a safe procedure but is associated with a 5.9% risk of grade-III or IV complications beyond the learning curve. The majority of these complications are resolved without permanent disability. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: George Grammatopoulos; Jeremy Wales; Alpesh Kothari; Harinderjit S Gill; Andrew Wainwright; Tim Theologis Journal: Clin Orthop Relat Res Date: 2016-05 Impact factor: 4.176
Authors: John C Clohisy; Jeffrey Ackerman; Geneva Baca; Jack Baty; Paul E Beaulé; Young-Jo Kim; Michael B Millis; David A Podeszwa; Perry L Schoenecker; Rafael J Sierra; Ernest L Sink; Daniel J Sucato; Robert T Trousdale; Ira Zaltz Journal: J Bone Joint Surg Am Date: 2017-01-04 Impact factor: 5.284
Authors: Eduardo N Novais; Patrick M Carry; Lauryn A Kestel; Brian Ketterman; Christopher M Brusalis; Wudbhav N Sankar Journal: Clin Orthop Relat Res Date: 2017-04 Impact factor: 4.176
Authors: Joel Wells; Perry Schoenecker; Jeff Petrie; Kayla Thomason; Charles W Goss; John C Clohisy Journal: Clin Orthop Relat Res Date: 2019-05 Impact factor: 4.176