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The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches.

Questions/purposes

The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach.

Methods

A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13–44 months).

Results

Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21–29; p < 0.0001) and control groups (mean improvement, 21; 95% CI, 17–25; p < 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, −1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center-edge angle (p = 0.4463), anterior center-edge angle (p = 0.0936), and Tönnis angle (p = 0.7953) improvement when compared with the classic approach.

Conclusions

The rectus-preserving approach for PAO is as safe and effective as the classic approach to achieve radiographic correction and HHS improvement at minimum 1 year. Additional investigation is needed to determine whether the rectus-preserving approach allows for improvement in functional recovery including hip flexion strength.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Kerry Murray PA-C (Department of Orthopaedics, Children’s Hospital Boston), and Gloria Boye BA (Department of Orthopaedics, Children’s Hospital Boston) for contributions to data acquisition for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Children’s Hospital Colorado, Aurora, CO, USA

    Eduardo N. Novais MD & Patrick M. Carry BA

  2. Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Young-Jo Kim MD, PhD & Michael B. Millis MD

Authors
  1. Eduardo N. Novais MD
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  2. Young-Jo Kim MD, PhD
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  3. Patrick M. Carry BA
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  4. Michael B. Millis MD
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Corresponding author

Correspondence to Michael B. Millis MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at Boston Children’s Hospital, Boston, MA, USA.

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Novais, E.N., Kim, YJ., Carry, P.M. et al. The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?. Clin Orthop Relat Res 472, 3142–3149 (2014). https://doi.org/10.1007/s11999-014-3720-9

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  • DOI: https://doi.org/10.1007/s11999-014-3720-9

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