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Peri-acetabular osteotomy

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...
October 12, 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
A Malviya, W Dandachli, Z Beech, M J Bankes, J D Witt
Stress fractures occurring in the pubis and ischium after peri-acetabular osteotomy (PAO) are not well recognised, with a reported incidence of 2% to 3%. The purpose of this study was to analyse the incidence of stress fracture after Bernese PAO under the care of two high-volume surgeons. The study included 359 patients (48 men, 311 women) operated on at a mean age of 31.1 years (15 to 56), with a mean follow-up of 26 months (6 to 64). Complete follow-up radiographs were available for 348 patients, 64 of whom (18...
January 2015: Bone & Joint Journal
D Kosuge, T Cordier, L B Solomon, D W Howie
Peri-acetabular osteotomy is an established surgical treatment for symptomatic acetabular dysplasia in young adults. An anteroposterior radiograph of the pelvis is commonly used to assess the extent of dysplasia as well as to assess post-operative correction. Radiological prognostic factors include the lateral centre-edge angle, acetabular index, extrusion index and the acetabular version. Standing causes a change in the pelvis tilt which can alter certain radiological measurements relative to the supine position...
September 2014: Bone & Joint Journal
Satoshi Hamai, Yasuharu Nakashima, Mio Akiyama, Umito Kuwashima, Takuaki Yamamoto, Goro Motomura, Masanobu Ohishi, Yukihide Iwamoto
PURPOSE: Ischio-pubic stress fracture is one of the potential complications after peri-acetabular osteotomy (PAO) in patients with hip dysplasia. The purpose of this study was to examine the prevalence of and risk factors for ischio-pubic fractures following PAO. METHODS: A total of 296 hips in 275 patients who underwent transposition osteotomy of the acetabulum between 2001 and 2012 were retrospectively reviewed. Patient characteristics and radiographic parameters were compared between patients with and without fracture...
October 2014: International Orthopaedics
Cindy Mallet, B Ilharreborde, A Presedo, A Khairouni, K Mazda, G F Penneçot
PURPOSE: Hip subluxation is common in children with cerebral palsy (CP). Surgery is indicated in case of pain or progressive increase of Reimers index on radiographs. Peri-iliac osteotomy combined with femoral osteotomy is one of the numerous operative techniques available, but results at skeletal maturity remain unclear. The purpose of this radiological study was to report the long-term results of this procedure. MATERIALS AND METHODS: Twenty hips in 20 children were retrospectively evaluated at skeletal maturity...
May 2014: Journal of Children's Orthopaedics
Paul Whittingham-Jones, Nirav K Patel, Aresh Hashemi-Nejad
No abstract text is available yet for this article.
May 2014: Journal of Children's Orthopaedics
Paul Whittingham-Jones, Nirav Kirit Patel, Aresh Hashemi-Nejad
INTRODUCTION: A modification of the technique for performing the Bernese periacetabular osteotomy is described. MATERIALS AND METHODS: A medial approach to the Ischium and a subtle re-orientation of the pubic osteotomy are detailed. CONCLUSION: Surgical morbidity is likely decreased with a concurrent cosmetic advantage without compromise to surgical correction or patient safety.
March 2013: Journal of Children's Orthopaedics
K Okano, K Yamaguchi, Y Ninomiya, S Matsubayashi, M Osaki, K Takahashi
Patients with acetabular dysplasia commonly undergo peri-acetabular osteotomy after skeletal maturity to reduce the risk of the late development of osteoarthritis. Several studies have suggested that deformity of the femoral head influences the long-term outcome. We radiologically examined 224 hips in 112 patients with acetabular dysplasia and early-stage osteoarthritis. There were 103 women and nine men with a mean age of 37.6 years (18 to 49). A total of 201 hips were placed in the acetabular dysplasia group and 23 in a normal group...
September 2013: Bone & Joint Journal
Bungo Otsuki, Mitsuru Takemoto, Keiichi Kawanabe, Yasunari Awa, Haruhiko Akiyama, Shunsuke Fujibayashi, Takashi Nakamura, Shuichi Matsuda
PURPOSE: Curved peri-acetabular osteotomy (CPO) produces excellent clinical results, but the surgical procedure is technically demanding, and severe complications related to the osteotomy have been reported. To provide a safe, accurate surgical procedure, we have developed a novel method for setting the cutting line and direction. We have designed and made a custom cutting guide for individual patients. The purpose of the study was to evaluate the efficacy of this new method and cutting guide...
June 2013: International Orthopaedics
S Azegami, D Kosuge, M Ramachandran
Slipped capital femoral epiphysis (SCFE) is relatively common in adolescents and results in a complex deformity of the hip that can lead to femoroacetabular impingement (FAI). FAI may be symptomatic and lead to the premature development of osteoarthritis (OA) of the hip. Current techniques for managing the deformity include arthroscopic femoral neck osteochondroplasty, an arthroscopically assisted limited anterior approach to the hip, surgical dislocation, and proximal femoral osteotomy. Although not a routine procedure to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy has been successfully used to treat FAI caused by acetabular over-coverage...
April 2013: Bone & Joint Journal
Christine L Abraham, Steve A Maas, Jeffrey A Weiss, Benjamin J Ellis, Christopher L Peters, Andrew E Anderson
Quantifying cartilage contact stress is paramount to understanding hip osteoarthritis. Discrete element analysis (DEA) is a computationally efficient method to estimate cartilage contact stresses. Previous applications of DEA have underestimated cartilage stresses and yielded unrealistic contact patterns because they assumed constant cartilage thickness and/or concentric joint geometry. The study objectives were to: (1) develop a DEA model of the hip joint with subject-specific bone and cartilage geometry, (2) validate the DEA model by comparing DEA predictions to those of a validated finite element analysis (FEA) model, and (3) verify both the DEA and FEA models with a linear-elastic boundary value problem...
April 5, 2013: Journal of Biomechanics
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