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Bernese periacetabular osteotomy
K A Siebenrock1, E Schöll, M Lottenbach
1Department of Orthopaedic Surgery, University of Berne, Switzerland.
Insights
The Bernese periacetabular osteotomy effectively treats hip dysplasia, preserving the hip joint in most patients with good to excellent outcomes. Factors like patient age and osteoarthritis severity influence success rates.
Area of Science:
- Orthopedic Surgery
- Hip Preservation Surgery
- Skeletal Dysplasia
Background:
- Hip dysplasia is a common condition leading to pain and osteoarthritis.
- Bernese periacetabular osteotomy (PAO) is a surgical technique to correct hip dysplasia.
- Understanding long-term outcomes of PAO is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of Bernese PAO in treating symptomatic hip dysplasia.
- To identify factors associated with favorable and unfavorable surgical outcomes.
Main Methods:
- Retrospective analysis of 75 hip joints in 63 patients undergoing Bernese PAO.
- Radiographic assessment of hip joint parameters before and after surgery.
- Clinical follow-up evaluating hip joint preservation and functional outcomes.
Main Results:
- 95% of patients (71 hips) achieved a mean follow-up of 11.3 years.
- 82% of patients (58 hips) preserved their hip joint with 73% reporting good to excellent results.
- Factors predicting unfavorable outcomes included older age, severe osteoarthritis, labral tears, and inadequate acetabular correction.
Conclusions:
- Bernese PAO demonstrates significant potential for correcting hip dysplasia and preserving the hip joint long-term.
- Careful patient selection and surgical technique are important to optimize outcomes.
- Early intervention may be beneficial to avoid factors associated with poorer results.
Abstract:
Seventy-five symptomatic dysplastic hip joints (63 patients) were treated with the Bernese periacetabular osteotomy during a period of 44 months. The mean patients' age was 29 years (range, 13-56 years) and the female:male ratio was 3.4:1. Group III dysplasia according to Severin was seen in 50% and Group IV dysplasia was seen in 44% of the patients. Osteoarthritis was present in 58% of the patients. Followup was obtained at a mean of 11.3 years (range, 10-13.8 years) in 71 hip joints (95%). Radiographic measurements of the lateral center edge angle, anterior center edge angle, acetabular index, lateralization of the femoral head, and intactness of Shenton's line showed a high correction potential of this type of osteotomy. In 58 patients (82%) the hip joint was preserved at last followup with a good to excellent result in 73%. Unfavorable outcome was significantly associated with higher age of the patient, moderate to severe osteoarthritis at surgery, a labral lesion, less anterior coverage correction, and a suboptimal acetabular index. Major complications were encountered in the first 18 patients including an intraarticular cut in two, excessive lateralization in one, secondary loss of correction in two and femoral head subluxation in three patients.