Ganz Periacetabular Osteotomy for the Treatment of Developmental Dysplasia of the Hip: Initial Experience and Results From the First 44 Cases
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Published:
Dec 16, 2021
Keywords:
Dysplasia, hip, osteoarthrosis, labrum, osteotomy, Ganz
Main Article Content
Abstract
Objective: To describe the surgical technique, indications, and initial results of the Bernese periacetabular osteotomy (PAO) for the treatment of developmental dysplasia of the hip.
Materials and Methods: Between May 2011 and May 2020, 44 PAOs were performed in 44 patients (35 women) with an average age of 30 years (23-38). All patients had a diagnosis of symptomatic hip dysplasia. The average center-edge angle was 17 (9 to 20) and the average acetabular index was 18 (15 to 20). In 22 cases, the intra-articular findings were evaluated and repaired by arthroscopy in the same surgical stage. The correction obtained, the consolidation of the osteotomy, and the functional outcomes at the end of the follow-up were evaluated.
Results: Hypertrophy and rupture of the acetabular labrum associated with hip dysplasia were evidenced in 22 patients. Paralabral cysts were found in 10 patients in the series. The average postoperative center-edge angle was 32º (27º to 35º) and the acetabular index was 6º (4º to 9º). The surgical time for PAO was 130 minutes; in patients where an arthroscopic procedure was added, the time was 148 minutes.
Conclusions: PAO is technically demanding, but has predictable outcomes in patients with articular cartilage integrity and correctable deformities. Arthroscopy before osteotomy allows assessing cartilage conditions, diagnosing and treating intra-articular lesions associated with this pathology, and deciding on the need to correct the soft tissue deficit.
Materials and Methods: Between May 2011 and May 2020, 44 PAOs were performed in 44 patients (35 women) with an average age of 30 years (23-38). All patients had a diagnosis of symptomatic hip dysplasia. The average center-edge angle was 17 (9 to 20) and the average acetabular index was 18 (15 to 20). In 22 cases, the intra-articular findings were evaluated and repaired by arthroscopy in the same surgical stage. The correction obtained, the consolidation of the osteotomy, and the functional outcomes at the end of the follow-up were evaluated.
Results: Hypertrophy and rupture of the acetabular labrum associated with hip dysplasia were evidenced in 22 patients. Paralabral cysts were found in 10 patients in the series. The average postoperative center-edge angle was 32º (27º to 35º) and the acetabular index was 6º (4º to 9º). The surgical time for PAO was 130 minutes; in patients where an arthroscopic procedure was added, the time was 148 minutes.
Conclusions: PAO is technically demanding, but has predictable outcomes in patients with articular cartilage integrity and correctable deformities. Arthroscopy before osteotomy allows assessing cartilage conditions, diagnosing and treating intra-articular lesions associated with this pathology, and deciding on the need to correct the soft tissue deficit.
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Zanotti, G., Lucero, C. M., Díaz Dilernia, F., Slullitel, P., Comba, F., Piccaluga, F., & Buttaro, M. (2021). Ganz Periacetabular Osteotomy for the Treatment of Developmental Dysplasia of the Hip: Initial Experience and Results From the First 44 Cases. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(6), 727-736. https://doi.org/10.15417/issn.1852-7434.2021.86.6.1286
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Clinical Research
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References
1. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors
that predict the outcome. J Bone Joint Surg Am 1995;77(7):985-9. https://doi.org/10.2106/00004623-199507000-00002
2. Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural
instability: toward a comprehensive classification for acetabular dysplasia. J Arthroplasty 2017;32(9S):S20-S27.
https://doi.org/10.1016/j.arth.2017.02.067
3. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Sibenrock KA. Femoroacetabular impingement: a cause for
osteoarthritis of the hip. Clin Orthop Relat Res 2003(417):112-20. https://doi.org/10.1097/01.blo.0000096804.78689.c2
4. Ganz R, Klaue K, Vinh TS, Mast JW. The classic: A new periacetabular osteotomy for the treatment of hip
dysplasias. Clin Orthop Relat Res 2004;(418):3-8. https://doi.org/10.1097/00003086-200401000-00002
5. Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature
review. Clin Orthop Relat Res 2009;467(8):2041-52. https://doi.org/10.1007/s11999-009-0842-6
6. Garbuz DS, Awwad MA, Duncan CP. Periacetabular osteotomy and total hip arthroplasty in patients older than
40 years. J Arthroplasty 2008;23(7):960-3. https://doi.org/10.1016/j.arth.2007.08.015
7. Hsieh PH, Huang KC, Lee PC, Chang YH. Comparison of periacetabular osteotomy and total hip replacement in
the same patient: a two- to ten-year follow-up study. J Bone Joint Surg Br 2009;91(7):883-8.
https://doi.org/10.1302/0301-620X.91B7.22183
8. Sharifi E, Sharifi H, Morshed S, Bozic K, Diab M. Cost-effectiveness analysis of periacetabular osteotomy. J Bone
Joint Surg Am 2008;90(7):1447-56. https://doi.org/10.2106/JBJS.G.00730
9. Teratani T, Naito M, Kiyama T, Maeyama A. Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am 2010;92(1)31-41. https://doi.org/10.2106/JBJS.H.01556
10. Fujii M, Nakashima Y, Noguchi Y, Yamamoto T, Mawatari T, Motomura G, et al. Effect of intra-articular lesions
on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. J Bone Joint Surg Br
2011;93(11):1449-56. https://doi.org/10.1302/0301-620X.93B11.27314
11. Yasunaga Y, Ikuta Y, Kanazawa T, Takahashi K, Hisatome T. The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy. J Bone Joint Surg Br 2001;83(7):1001-4.
https://doi.org/10.1302/0301-620x.83b7.12171
12. Jawad MU, Scully SP. In brief: Crowe’s classification: arthroplasty in developmental dysplasia of the hip. Clin
Orthop Relat Res 2011;469(1):306-8. https://doi.org/10.1007/s11999-010-1316-6
13. Kovalenko B, Bremjit P, Fernando N. Classifications in Brief: Tönnis classification of hip osteoarthritis. Clin Orthop Relat Res 2018;476(8):1680-4. https://doi.org/10.1097/01.blo.0000534679.75870.5f
14. Byrd JW, Pappas JN, Pedley MJ. Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures. Arthroscopy 1995;11(4):418-23. https://doi.org/10.1016/0749-8063(95)90193-0
15. Leunig M, Ganz R. Berner periazetabuläre Osteotomie [The Bernese method of periacetabular osteotomy].
Orthopade 1998;27(11):743-50. https://doi.org/10.1007/pl00003460
16. Fitz-Henry J. The ASA classification and peri-operative risk. Ann R Coll Surg Engl 2011;93(3):185-7.
https://doi.org/10.1308/rcsann.2011.93.3.185a
17. Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev 2018;3(4):136-48.
https://doi.org/10.1302/2058-5241.3.170018
18. Marsell R, Einhorn TA. The biology of fracture healing. Injury 2011;42(6):551-5. https://doi.org/10.1016/j.injury.2011.03.031
19. Beck M, Leunig M, Ellis T, Sledge JB, Ganz R. The acetabular blood supply: implications for periacetabular
osteotomies. Surg Radiol Anat 2003;25(5-6):361-7. https://doi.org/10.1007/s00276-003-0149-3
20. Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt? Clin Orthop Relat Res 2015;473(4):1255-66.
https://doi.org/10.1007/s11999-014-3936-8
21. Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am 2006;88(9):1920-6. https://doi.org/10.2106/JBJS.E.00515
22. Pogliacomi F, Stark A, Wallensten R. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years. Acta Orthop 2005;76(1):67-74. https://doi.org/10.1080/00016470510030346
23. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year follow-up of Bernese periacetabular
osteotomy. Clin Orthop Relat Res 2008;466(7):1633-44. https://doi.org/10.1007/s11999-008-0242-3
24. Trousdale RT, Cabanela ME. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthop Scand 2003;74(2):119-26. https://doi.org/10.1080/00016470310013824
25. Okano K, Enomoto H, Osaki M, Shindo H. Joint congruency as an indication for rotational acetabular
osteotomy. Clin Orthop Relat Res 2009;467:894-900. https://doi.org/10.1007/s11999-008-0443-9
26. Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of
conversion to total hip replacement. J Bone Joint Surg Am 2009;91(9):2169-79. https://doi.org/10.2106/JBJS.H.00994
that predict the outcome. J Bone Joint Surg Am 1995;77(7):985-9. https://doi.org/10.2106/00004623-199507000-00002
2. Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural
instability: toward a comprehensive classification for acetabular dysplasia. J Arthroplasty 2017;32(9S):S20-S27.
https://doi.org/10.1016/j.arth.2017.02.067
3. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Sibenrock KA. Femoroacetabular impingement: a cause for
osteoarthritis of the hip. Clin Orthop Relat Res 2003(417):112-20. https://doi.org/10.1097/01.blo.0000096804.78689.c2
4. Ganz R, Klaue K, Vinh TS, Mast JW. The classic: A new periacetabular osteotomy for the treatment of hip
dysplasias. Clin Orthop Relat Res 2004;(418):3-8. https://doi.org/10.1097/00003086-200401000-00002
5. Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature
review. Clin Orthop Relat Res 2009;467(8):2041-52. https://doi.org/10.1007/s11999-009-0842-6
6. Garbuz DS, Awwad MA, Duncan CP. Periacetabular osteotomy and total hip arthroplasty in patients older than
40 years. J Arthroplasty 2008;23(7):960-3. https://doi.org/10.1016/j.arth.2007.08.015
7. Hsieh PH, Huang KC, Lee PC, Chang YH. Comparison of periacetabular osteotomy and total hip replacement in
the same patient: a two- to ten-year follow-up study. J Bone Joint Surg Br 2009;91(7):883-8.
https://doi.org/10.1302/0301-620X.91B7.22183
8. Sharifi E, Sharifi H, Morshed S, Bozic K, Diab M. Cost-effectiveness analysis of periacetabular osteotomy. J Bone
Joint Surg Am 2008;90(7):1447-56. https://doi.org/10.2106/JBJS.G.00730
9. Teratani T, Naito M, Kiyama T, Maeyama A. Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am 2010;92(1)31-41. https://doi.org/10.2106/JBJS.H.01556
10. Fujii M, Nakashima Y, Noguchi Y, Yamamoto T, Mawatari T, Motomura G, et al. Effect of intra-articular lesions
on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. J Bone Joint Surg Br
2011;93(11):1449-56. https://doi.org/10.1302/0301-620X.93B11.27314
11. Yasunaga Y, Ikuta Y, Kanazawa T, Takahashi K, Hisatome T. The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy. J Bone Joint Surg Br 2001;83(7):1001-4.
https://doi.org/10.1302/0301-620x.83b7.12171
12. Jawad MU, Scully SP. In brief: Crowe’s classification: arthroplasty in developmental dysplasia of the hip. Clin
Orthop Relat Res 2011;469(1):306-8. https://doi.org/10.1007/s11999-010-1316-6
13. Kovalenko B, Bremjit P, Fernando N. Classifications in Brief: Tönnis classification of hip osteoarthritis. Clin Orthop Relat Res 2018;476(8):1680-4. https://doi.org/10.1097/01.blo.0000534679.75870.5f
14. Byrd JW, Pappas JN, Pedley MJ. Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures. Arthroscopy 1995;11(4):418-23. https://doi.org/10.1016/0749-8063(95)90193-0
15. Leunig M, Ganz R. Berner periazetabuläre Osteotomie [The Bernese method of periacetabular osteotomy].
Orthopade 1998;27(11):743-50. https://doi.org/10.1007/pl00003460
16. Fitz-Henry J. The ASA classification and peri-operative risk. Ann R Coll Surg Engl 2011;93(3):185-7.
https://doi.org/10.1308/rcsann.2011.93.3.185a
17. Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev 2018;3(4):136-48.
https://doi.org/10.1302/2058-5241.3.170018
18. Marsell R, Einhorn TA. The biology of fracture healing. Injury 2011;42(6):551-5. https://doi.org/10.1016/j.injury.2011.03.031
19. Beck M, Leunig M, Ellis T, Sledge JB, Ganz R. The acetabular blood supply: implications for periacetabular
osteotomies. Surg Radiol Anat 2003;25(5-6):361-7. https://doi.org/10.1007/s00276-003-0149-3
20. Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt? Clin Orthop Relat Res 2015;473(4):1255-66.
https://doi.org/10.1007/s11999-014-3936-8
21. Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am 2006;88(9):1920-6. https://doi.org/10.2106/JBJS.E.00515
22. Pogliacomi F, Stark A, Wallensten R. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years. Acta Orthop 2005;76(1):67-74. https://doi.org/10.1080/00016470510030346
23. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year follow-up of Bernese periacetabular
osteotomy. Clin Orthop Relat Res 2008;466(7):1633-44. https://doi.org/10.1007/s11999-008-0242-3
24. Trousdale RT, Cabanela ME. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthop Scand 2003;74(2):119-26. https://doi.org/10.1080/00016470310013824
25. Okano K, Enomoto H, Osaki M, Shindo H. Joint congruency as an indication for rotational acetabular
osteotomy. Clin Orthop Relat Res 2009;467:894-900. https://doi.org/10.1007/s11999-008-0443-9
26. Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of
conversion to total hip replacement. J Bone Joint Surg Am 2009;91(9):2169-79. https://doi.org/10.2106/JBJS.H.00994