A minimally invasive periacetabular osteotomy technique: minimizing intraoperative risks.
Shankar Thiagarajah1, Joshua S Bingham2, George Grammatopoulos3
1Department of Orthopaedic Surgery, Doncaster & Bassetlaw Teaching Hospitals, Thorne Road, Doncaster DN2 5LT, UK.
Journal of Hip Preservation Surgery
|May 5, 2021
Summary
This study details a safer periacetabular osteotomy (PAO) technique, focusing on precise measurements and specific osteotomes to prevent nerve damage during the posterior column cut. The modified approach ensures reproducibility and minimizes risks to adjacent neurovascular structures.
Area of Science:
- Orthopedic surgery
- Surgical technique innovation
Background:
- Periacetabular osteotomy (PAO) carries risks to neurovascular structures.
- Surgeon experience significantly impacts PAO outcomes.
- Detailed, safe, and reproducible osteotomy techniques are lacking.
Purpose of the Study:
- To describe a modified periacetabular osteotomy technique emphasizing safety.
- To detail methods for preventing neurovascular injury during PAO.
Main Methods:
- Computerized tomography (CT)-based measurements of posterior column width.
- Use of specific-width osteotomes for the posterior column cut.
- Medial to lateral trajectory with pre-measured depth osteotomes for proximal lateral cortex cuts.
Main Results:
- The described technique resulted in no major vascular or nerve injuries in 530 PAOs.
- Minor lateral femoral cutaneous nerve issues were the only nerve complications.
- Intraoperative electromyography was not required.
Conclusions:
- The modified PAO technique enhances safety and reproducibility.
- Precise measurements and specialized osteotomes mitigate risks of nerve and vascular injury.
- This approach offers a safer alternative for periacetabular osteotomy.
