Acetabular osteochondroplasty and simultaneous reorientation: background and validation of concept

Most hips with femoroacetabular impingement (FAI) have combinations of femoral and acetabular abnormalities, including acetabular deficiency in some cases. Other impinging hips have large acetabular hyaline cartilage lesions that, when treated by resection, lead to acetabular deficiency and the need for a subsequent reorientation to improve coverage. Ideally, large cartilage lesions could be identified preoperatively and treated with 1 procedure. Therefore, a single operative approach that allows for both femoral and acetabular osteochondroplasty where needed, as well as simultaneous acetabular reorientation, is advantageous. We hypothesized that the addition of traction and dry arthroscopy via the Smith-Petersen approach at the time of periacetabular osteotomy could allow for the diagnosis and treatment of intra-articular labral and hyaline cartilage lesions and simultaneous acetabular reorientation. To validate this concept, we performed the procedure on cadaveric hips and subsequently treated a series of patients successfully (4 hips with limited anterior debridement and dry arthroscopy and 1 hip with a simultaneous periacetabular osteotomy). There were no intra- or postoperative complications in the series of 5 hips. The addition of traction and dry arthroscopy can permit the diagnosis and treatment of intra-articular lesions in reorienting periacetabular osteotomy. This enables the surgeon to address both acetabular cartilage and labral lesions, as well as idealizing acetabular orientation and coverage in 1 setting with less morbidity.