A Minimally Invasive Technique Using a Modified Stoppa Approach for Periacetabular Osteotomy: A Preliminary Cadaveric...

Area of Science:

• Orthopedic surgery
• Hip reconstruction
• Surgical anatomy

Background:

• Developmental hip dysplasia involves insufficient coverage of the femoral head by the acetabulum.
• Traditional Smith-Peterson incisions for Bernese osteotomy cause significant muscle dissection and scarring.
• Alternative approaches are needed to improve surgical outcomes for hip dysplasia.

Purpose of the Study:

• To evaluate the modified Stoppa approach for Bernese periacetabular osteotomy (PAO).
• To assess the feasibility and effectiveness of a less invasive two-incision technique.

Main Methods:

• Ten hemipelvises from five cadavers were utilized.
• A modified Stoppa incision was employed for exposure, followed by pubic and ischial osteotomies.
• A second lateral incision facilitated iliac osteotomy, with measurements of displacement performed clinically and radiographically.

Main Results:

• Mean anterior coverage improved significantly, with the center-edge angle increasing from 22.8° to 44.1°.
• Osteotomy displacement measured 22.1 mm anteriorly on radiographs and 17.8 mm clinically, with 20.3 mm lateral displacement.
• Posterior intact bone enlargement at the quadrilateral surface averaged 5.3 mm.

Conclusions:

• The modified Stoppa approach is a viable and less traumatic technique for Bernese PAO.
• This two-incision method allows direct visualization for bone cuts, potentially decreasing fluoroscopy dependence.