Percutaneous acetabuloplasty: a cadaveric study

Periacetabular osteolysis is a common etiology of prosthesis failure in patients who undergo total hip arthroplasty. These lesions are treated by open and, more recently, percutaneous techniques. The purpose of this study was to determine the relevant surface anatomy and bony landmarks in establishing percutaneous access to periacetabular regions and identifying critical at-risk structures in establishing access. Percutaneous access to the periacetabular region was established superiorly, anteroinferiorly, and posteroinferiorly by using 5 L5-to-mid thigh fixed cadaver pelvises with latex-injected vessels using threaded guidewires. Dissection was completed to identify structures at risk, with the distance from the wires recorded to the nearest millimeter. C-arm position for the optimal visualization and placement of guidewires was recorded. Average distance from the pin and the at-risk structures ranged from 11.2 to 38.7 mm. All 3 approaches allowed for safe percutaneous access to the periacetabular regions without injuring significant anatomical structures. This study established safe starting points and orientation for guidewires and radiograph projections associated with percutaneous access to the periacetabular regions. The findings in this study will be useful for developing minimally invasive approaches to these regions for the treatment of osteolytic lesions of diverse etiology. However, a biomechanical evaluation of the impact of these bony channels on the strength of pelvis under physiological and unanticipated loading must be performed before this technique can be safely translated to clinical practice.