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Peri-acetabular osteotomy

Jinxin Yang, Zhendong Zhang, Hui Cheng, Kai Xiao, Dianzhong Luo, Hong Zhang
AIM: To investigate the incidence, risk factors, and the last follow-up recovery status of sciatic and femoral nerve injury among patients who received Bernese peri-acetabular osteotomy (PAO). PATIENTS AND METHODS: The clinical file of 643 consecutive patients who received PAO from June 2012 to June 2016 was retrospectively reviewed. The number of nerve injury patients was calculated and the causes of injury were recorded. RESULTS: The sciatic or femoral nerve injury occurred in eight patients (1...
June 18, 2018: International Orthopaedics
Shinya Hayashi, Shingo Hashimoto, Tomoyuki Matsumoto, Koji Takayama, Nao Shibanuma, Kazunari Ishida, Kotaro Nishida, Ryosuke Kuroda
PURPOSE: The aim of study is to evaluate the accuracy of a navigation system during curved peri-acetabular osteotomy (CPO). METHODS: Forty-seven patients (53 hips) with hip dysplasia were enrolled and underwent CPO with or without navigation during surgery. Clinical and radiographical evaluations were performed and compared between the navigation group and non-navigation group, post-operatively. RESULTS: The clinical outcomes were not significantly different between the navigation and non-navigation groups...
March 26, 2018: International Orthopaedics
Elhadi Sariali, Filippo Vandenbulcke
PURPOSE: Although the arthroscopic management of femoroacetabular impingement (FAI) is increasing, severe complications have been reported due to traction. We developed an arthroscopic technique based on an initial capsulotomy and a minimal traction approach. The main purpose of this study was to analyze the clinical outcomes of FAI treatment using this technique after at least two years of follow-up. METHODS: Forty-seven consecutive patients underwent surgery for FAI...
March 23, 2018: International Orthopaedics
Silvio Pflugi, Rakesh Vasireddy, Till Lerch, Timo M Ecker, Moritz Tannast, Nane Boemke, Klaus Siebenrock, Guoyan Zheng
OBJECTIVE: To develop a hybrid augmented marker-based navigation system for acetabular reorientation during peri-acetabular osteotomy (PAO). METHODS: The system consists of a tracking unit attached to the patient's pelvis, augmented marker attached to the acetabular fragment and a host computer to do all the computations and visualization. The augmented marker is comprised of an external planar Aruco marker facing toward the tracking unit and an internal inertial measurement unit (IMU) to measure its orientation...
February 2018: International Journal of Computer Assisted Radiology and Surgery
Silvio Pflugi, Rakesh Vasireddy, Till Lerch, Timo M Ecker, Moritz Tannast, Nane Boemke, Klaus Siebenrock, Guoyan Zheng
We developed and validated a small, easy to use and cost-effective augmented marker-based hybrid navigation system for peri-acetabular osteotomy (PAO) surgery. The hybrid system consists of a tracking unit directly placed on the patient's pelvis, an augmented marker with an integrated inertial measurement unit ('MU) attached to the patient's acetabular fragment and the host computer. The tracking unit sends a live video stream of the marker to the host computer where the marker's pose is estimated. The augmented marker with the 'MU sends its pose estimate to the host computer where we apply sensor fusion to compute the final marker pose estimate...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Shunsuke Akiho, Koichi Kinoshita, Ayumi Matsunaga, Satohiro Ishii, Hajime Seo, Jun Nishio, Takuaki Yamamoto
BACKGROUND: Pubic bone nonunion and delayed union are reported as post-operative complications after peri-acetabular osteotomy (PAO). However, few studies have determined the incidence of delayed union using computed tomography (CT) scans. This study aimed to determine the incidence of delayed union at one year after PAO using X-ray and CT scans. METHODS: We performed a retrospective review of 150 hips in 132 consecutive patients with acetabular dysplasia who underwent PAO between January 2012 and June 2016 and evaluated 107 hips for which pelvic CT scans taken at one year after PAO were available...
May 2018: International Orthopaedics
M Leunig, H M Manner, L Turchetto, R Ganz
NEW PATHOPHYSIOLOGICAL INSIGHTS: Based on improved knowledge of the vascular supply of the proximal femur, a safe surgical dislocation of the hip joint was established allowing direct insights to the pathomorphological malfunctioning of the joint. One insight was that slipped capital femoral epiphysis (SCFE) impingement leads to substantial damage of the chondrolabral rim area, even in the presence of minor slips. A further surgical development was the extended retinacular flap allowing for correction of the deformity with calculable risk for iatrogenic necrosis...
April 2017: Journal of Children's Orthopaedics
Spencer J Knight, Christine L Abraham, Christopher L Peters, Jeffrey A Weiss, Andrew E Anderson
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...
November 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
P E Beaulé, H Bleeker, A Singh, J Dobransky
AIMS: Joint-preserving surgery of the hip (JPSH) has evolved considerably and now includes a number of procedures, including arthroscopy, surgical dislocation, and redirectional osteotomies of the femur and acetabulum. There are a number of different factors which lead to failure of JPSH. Consequently, it is of interest to assess the various modes of failure in order to continue to identify best practice and the indications for these procedures. PATIENTS AND METHODS: Using a retrospective observational study design, we reviewed 1013 patients who had undergone JPSH by a single surgeon between 2005 and 2015...
March 2017: Bone & Joint Journal
C L Abraham, S J Knight, C L Peters, J A Weiss, A E Anderson
OBJECTIVE: Using a validated, patient-specific finite element (FE) modeling protocol, we evaluated cartilage and labrum (i.e., chondrolabral) mechanics before and after peri-acetabular osteotomy (PAO) to provide insight into the ability of this procedure to improve mechanics in dysplastic hips. DESIGN: Five patients with acetabular dysplasia were recruited in this case-controlled, prospective study. Models, which included anatomy for bone, cartilage, and labrum, were generated from computed tomography (CT) arthrography scans acquired before and after PAO...
May 2017: Osteoarthritis and Cartilage
A Dangin, N Tardy, M Wettstein, O May, N Bonin
With the development of conservative hip surgery techniques, new entities such as microinstability have been identified. Microinstability is a painful supra-physiological mobility of the hip. It results from the association of architectural and functional abnormalities impairing joint stability. These risk factors concern hip joint bone architecture or peri-articular soft tissues. Bone abnormalities are identified on hip assessment parameters. Soft tissues also play a key role in the static and dynamic stability of the hip: the joint capsule, labrum, ligamentum teres and adjacent myotendinous structures affect joint coaptation; any abnormality or iatrogenic lesion concerning these structures may constitute a risk factor for microinstability...
December 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Nicolas de l'Escalopier, Philippe Anract, David Biau
There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance...
June 2016: Annals of Physical and Rehabilitation Medicine
Dean K Matsuda, Nicole A Matsuda
Beyond the recent expansion of extra-articular hip arthroscopy into the peri-trochanteric and subgluteal space, this instructional course lecture introduces three innovative procedures: endoscopy-assisted periacetabular osteotomy, closed derotational proximal femoral osteotomy and endoscopic pubic symphysectomy. Supportive rationale, evolving indications, key surgical techniques and emerging outcomes are presented for these innovative less invasive procedures.
July 2015: Journal of Hip Preservation Surgery
Kelly L Adler, P Christopher Cook, Paul R Geisler, Yi-Meng Yen, Brian D Giordano
CONTEXT: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes...
January 2016: Sports Health
G I Wassilew, C Perka, V Janz, M Krämer, L Renner
We have investigated the effect of using tranexamic acid (TXA) during peri-acetabular osteotomy (PAO) on peri-operative blood loss and blood transfusion requirements. In addition we analysed whether the use of TXA was associated with an increased risk of venous thromboembolism (VTE) following this procedure. A consecutive series of 96 PAOs, performed by a single surgeon, were reviewed. A total of 48 patients received TXA and 48 did not. The TXA group received a continuous infusion of TXA at a rate of 10 mg/kg/h...
December 2015: Bone & Joint Journal
Yunfang Zhen, Chunhua Yin, Shiping Tan, Quanwen Yuan, Lunqing Zhu, Xiaodong Wang
PURPOSE: Open surgery, nonsurgical positioning device and casting are mainstay treatments of developmental dysplasia of the hip (DDH). The optimal indicators for surgical interventions remain unclear. In this study, we aim to establish empirical, sensitive radiographic indicators for peri-acetabular osteotomy intervention in developmental dysplasia in Chinese children. METHODS: One hundred and three DDH patients treated in The Soochow University Children's Hospital between 2006 and 2012 were assessed; patients with known causes of neuron muscular and abnormal hip joint origin were excluded...
February 2016: International Orthopaedics
Kelly L Adler, P Christopher Cook, Yi-Meng Yen, Brian D Giordano
CONTEXT: An evolution in conceptual understanding, coupled with technical innovations, has enabled hip preservation surgeons to address complex pathomorphologies about the hip joint to reduce pain, optimize function, and potentially increase the longevity of the native hip joint. Technical aspects of hip preservation surgeries are diverse and range from isolated arthroscopic or open procedures to hybrid procedures that combine the advantages of arthroscopy with open surgical dislocation, pelvic and/or proximal femoral osteotomy, and biologic treatments for cartilage restoration...
November 2015: Sports Health
Tetsuya Sakamoto, Masatoshi Naito, Yoshinari Nakamura
PURPOSE: Peri-acetabular osteotomy, especially curved peri-acetabular osteotomy, is an effective surgical procedure for re-orientating the acetabulum. However, there have been few reports on this procedure in teenagers. The purpose of this study was to investigate the treatment outcomes of curved peri-acetabular osteotomy in teenagers. METHODS: We retrospectively reviewed 33 hips in 27 teenage patients with acetabular dysplasia who underwent curved peri-acetabular osteotomy between 1995 and 2012...
November 2015: International Orthopaedics
M Kalhor, J Gharehdaghi, R Schoeniger, R Ganz
The modified Smith-Petersen and Kocher-Langenbeck approaches were used to expose the lateral cutaneous nerve of the thigh and the femoral, obturator and sciatic nerves in order to study the risk of injury to these structures during the dissection, osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely to occur if an osteotomy of the anterior superior iliac spine had been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected osteotomy of the pubis if the far cortex was penetrated by > 5 mm...
May 2015: Bone & Joint Journal
E N Novais, G D Potter, J C Clohisy, M B Millis, Y J Kim, R T Trousdale, P M Carry, R J Sierra
Obesity is a risk factor for complications following many orthopaedic procedures. The purpose of this study was to investigate whether obesity was an independent risk factor increasing the rate of complications following periacetabular osteotomy (PAO) and to determine whether radiographic correction after PAO was affected by obesity. We retrospectively collected demographic, clinical and radiographic data on 280 patients (231 women; 82.5% and 49 men; 17.5%) who were followed for a mean of 48 months (12 to 60) after PAO...
January 2015: Bone & Joint Journal
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