Related Experiment Video
Updated: Mar 24, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
CADAVERIC STUDY ON THE LEARNING CURVE OF THE TWO-APPROACH GANZ PERIACETABULAR OSTEOTOMY
Fernando Portilho Ferro1, Leandro Ejnisman1, Helder Souza Miyahara1
1. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil.
Objective:
: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications.
Methods:
: We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts.
Results:
: Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures.
Conclusions:
: We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches.
Evidence Level:
IV, Cadaveric Study.
