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Spherical Periacetabular Osteotomy.

Toshihiko Hara1, Ayumi Kaneuji2, Kazuhiko Sonoda1

  • 1Department of Orthopaedic Surgery, Iizuka Hospital, Iizuka, Fukuoka, Japan.

JBJS Essential Surgical Techniques
|February 23, 2023
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Summary

Spherical periacetabular osteotomy (SPO) offers a safer alternative to Bernese periacetabular osteotomy for hip dysplasia, reducing complications. This technique utilizes 3D planning for improved outcomes in preventing osteoarthritis progression.

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Area of Science:

  • Orthopedic surgery
  • Hip reconstruction
  • Osteoarthritis prevention

Background:

  • Periacetabular osteotomy techniques aim to halt osteoarthritis in dysplastic hips.
  • Bernese periacetabular osteotomy (BPO) is common but has risks like nonunion and vascular damage.
  • Spherical periacetabular osteotomy (SPO) was developed to address BPO's limitations.

Purpose of the Study:

  • To describe the technique and advantages of Spherical periacetabular osteotomy (SPO).
  • To highlight SPO's potential to overcome complications associated with Bernese periacetabular osteotomy.

Main Methods:

  • Utilizes preoperative 3D planning for precise osteotomy.
  • Involves a curved osteotome and specific bone groove creation.
  • Preserves the quadrilateral surface (QLS) and pubis, unlike BPO.
  • Employs a medial wedge-shaped osteotomy at the iliac crest.

Main Results:

  • SPO preserves the quadrilateral surface (QLS) and obturator artery.
  • Offers a stable pelvic ring postoperatively with reduced nonunion risk.
  • Features a small incision and potentially faster muscle recovery.
  • Medial wedge osteotomy protects the lateral femoral cutaneous nerve.

Conclusions:

  • SPO is a safe and effective alternative for hip dysplasia when using proper 3D planning and surgical technique.
  • The technique offers advantages in pelvic stability and reduced surgical risks compared to BPO.
  • Careful rehabilitation is necessary due to potential early postoperative fragment mobility.