Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a
Onur Hapa1, Onur Gürsan1, Osman Nuri Eroğlu1
1Department of Orthopedic Surgery, Dokuz Eylül University, 35330, Balçova, İzmir, Turkey.
Insights
This study identifies key anatomical measurements in hip dysplasia to improve Bernese periacetabular osteotomy (PAO) surgical precision. Understanding these distances helps prevent complications like joint damage or fractures during PAO procedures.
Area of Science:
- Orthopedic Surgery
- Radiology
- Human Anatomy
Background:
- Bernese periacetabular osteotomy (PAO) is a surgical technique for hip dysplasia.
- Technical difficulties and unclear surgical steps in PAO can lead to iatrogenic joint entrance or posterior column fracture.
- Precise anatomical understanding is crucial for successful PAO outcomes.
Purpose of the Study:
- To identify and correlate key anatomical distances in hips with and without dysplasia.
- To provide intraoperative guidance for PAO to prevent surgical complications.
- To enhance the safety and efficacy of the Bernese periacetabular osteotomy.
Main Methods:
- 3D CT scans of 27 dysplastic hips (CE < 25°) and 27 non-dysplastic hips (CE > 25°) were analyzed.
- Measurements included ischium width, distances from infra-acetabular groove to ischial spine, ASIS to joint/sciatic notch/spine, and acetabulum to posterior column/ischial spine/sciatic notch.
- Correlations between these anatomical distances and clinical outcomes were evaluated.
Main Results:
- Dysplastic hips showed significantly shorter distances from the infra-acetabular groove to the ischial spine (P: 0.03), ASIS to the joint (P: 0.03), and acetabulum to the posterior column (P: 0.005).
- The distance from the anterior superior iliac spine (ASIS) to the sciatic notch correlated with other critical measurements.
- These findings suggest specific anatomical landmarks can predict osteotomy depth and width.
Conclusions:
- The distance from the ASIS to the sciatic notch is a valuable intraoperative predictor for PAO.
- This measurement can guide surgeons in determining osteotomy depth and width, reducing the risk of intra-articular extension or posterior column fracture.
- The study provides crucial anatomical data to improve PAO surgical technique and patient safety.
Abstract:
As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first 'ischial' cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42 ± 4, 44 ± 4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34 ± 2, 36 ± 2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.
