Approaches and perioperative management in periacetabular osteotomy surgery: the minimally invasive transsartorial approach

In the early days of periacetabular osteotomy (PAO), surgical approaches were characterized by extensive soft-tissue dissection. The Smith-Petersen approach (and iliofemoral modifications) and the ilioinguinal approach have traditionally been used for PAO. The optimal surgical approach for PAO, or any surgical procedure, should be characterized by few complications, minimized surgical trauma, and no compromise of long-term surgical results. A minimally invasive transsartorial approach using fluoroscopy and an approximately 7-cm skin incision has been developed for performing PAO. No muscles are detached, and the femoral nerve and vessels are protected by the iliopsoas and sartorius muscles. This approach is safe, minimizes blood loss and transfusion requirements, is associated with a short duration of surgery, and allows for optimal correction of the acetabular fragment. Follow-ups (range, 3.9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies (local infiltration analgesia), and a progressive mobilization and exercise program. The transsartorial approach coupled with a specific perioperative management program has proved successful for PAO surgery.