Acetabular blood flow during Bernese periacetabular osteotomy: an intraoperative study using laser Doppler flowmetry

Area of Science:

• Orthopedic Surgery
• Hip Dysplasia Treatment
• Vascular Perfusion Studies

Background:

• Juxtaarticular pelvic osteotomies, including the Bernese periacetabular osteotomy (PAO), are used for hip dysplasia.
• Concerns exist regarding blood flow to the acetabular fragment after PAO.
• Direct measurements of acetabular perfusion following PAO were previously lacking.

Purpose of the Study:

• To measure acetabular perfusion during and after the Bernese periacetabular osteotomy (PAO).
• To assess the dynamic changes in blood flow to the acetabular fragment during surgical correction of hip dysplasia.

Main Methods:

• Laser Doppler flowmetry was used to measure intraosseous blood flow in 10 patients undergoing PAO.
• Measurements were taken sequentially after specific surgical steps.
• Dynamic changes in small vessel blood flow were reliably depicted by intraosseous high-energy laser Doppler.

Main Results:

• A significant 77% decrease in blood flow was observed after acetabular fragment separation.
• Fragment repositioning caused no further blood flow drop but reduced pulsatility in most patients.
• Blood flow and pulsatility gradually recovered after a 30-minute rest period, with 60% showing pulsatile flow at surgery's end.

Conclusions:

• PAO leads to a temporary but significant reduction in supraacetabular blood flow.
• Reversible changes in blood perfusion were indicated by recovery of pulsatile flow.
• All PAO osteotomies healed successfully within eight weeks, with no signs of necrosis at 1-year follow-up.