OBJECTIVE: : The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. METHODS: : We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. RESULTS: : Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. CONCLUSIONS: : We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. EVIDENCE LEVEL: IV, Cadaveric Study.
OBJECTIVE: : The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. METHODS: : We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. RESULTS: : Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. CONCLUSIONS: : We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. EVIDENCE LEVEL: IV, Cadaveric Study.
Entities:
Keywords:
Arthritis; Autopsy; Cadaver; Hip dislocation, Congenital; Osteotomy
Authors: John C Clohisy; Susan E Barrett; J Eric Gordon; Eliana D Delgado; Perry L Schoenecker Journal: J Bone Joint Surg Am Date: 2006-03 Impact factor: 5.284
Authors: Bruno Gonçalves Schröder E Souza; Flavia de Souza Bastos; Valdeci Manoel de Oliveira; Alfredo Chaoubah Journal: Case Rep Orthop Date: 2020-06-15