Periacetabular osteotomy without abductor dissection using direct anterior exposure.

Area of Science:

• Orthopedic Surgery
• Hip Preservation Surgery

Background:

• The Smith-Petersen approach for periacetabular osteotomy (PAO) is associated with abductor muscle morbidity.
• Intra-articular hip pathology is common in adult PAO candidates.

Purpose of the Study:

• To introduce and evaluate the direct anterior exposure, an abductor-sparing surgical approach for PAO.
• To assess the efficacy of the direct anterior exposure in addressing intra-articular hip disease.

Main Methods:

• The direct anterior exposure combines elements of the Smith-Petersen and ilioinguinal approaches.
• An osteotomy of the anterior superior iliac spine facilitates the exposure.
• The study reviewed 195 consecutive PAOs using either a limited (one window) or full (two windows) direct anterior approach.

Main Results:

• Both limited and full direct anterior approaches yielded comparable functional and radiographic results.
• Patients experienced rapid functional recovery, excellent radiographic correction, and quick bony healing.
• Abductor function returned to preoperative levels by 3 months post-surgery, with no osteonecrosis or vascular injuries reported.

Conclusions:

• The direct anterior exposure is a safe and effective abductor-sparing approach for PAO.
• The limited direct anterior approach is suitable for most patients, while the full approach benefits larger male patients.
• This technique minimizes abductor morbidity compared to the traditional Smith-Petersen approach.