Abstract
Background
Developmental hip dysplasia is diagnosed when the femoral head is not sufficiently covered by the acetabulum. Anterior and lateral cover deficiency is seen, as a result a dysplastic hip joint. Various incision modifications have been developed because of the muscle dissection and wide wound scar in Smith-Peterson incision, which was originally used in Bernese osteotomy. This study evaluates applicability of the modified Stoppa approach in the performance of Bernese periacetabular osteotomy (PAO).
Materials and Methods
Ten hemipelvises of five donor cadavers were used. The transverse Stoppa incision was made 2 cm over the symphysis pubis for quadrilateral surface exposure and pubic and ischial bone osteotomies. The second skin incision, a few centimeters lateral to the original incision, was made along the tensor fascia lata. Iliac bone osteotomy was performed starting just above the rectus femoris insertion. The displacement of the osteotomy was measured clinically and radiographically.
Results
The mean anterior coverage calculated with center-edge angle was improved from 22.8° ±2.8 (range 20° min-28° max) preoperatively to 44.1° ± 3.7 (range 36° min-48° max). The displacement of the osteotomy at the iliopectineal line calculated on the iliac inlet view radiographs was 22.1 ± 3.4 mm (range 15 mm min-26 mm max). The clinical amount of the anterior displacement on the cadavers was 17.8 ± 3.35 mm (range 11 mm-21 mm) and lateral displacement was 20.3 ± 3.23 mm (range 15 mm-24 mm). The amount of the posterior intact bone enlargement at the quadrilateral surface was 5.3 ± 0.48 mm.
Conclusion
This less traumatic two-incision exposure is an adequate technique for Bernese PAO, allowing the bone to be cut under direct visual observation and reducing the need to use fluoroscopy.
Similar content being viewed by others
References
Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988;232:6–36.
Shiramizu K, Naito M, Asayama I, Yatsunami M. A quantitative anatomic characterization of the quadrilateral surface for periacetabular osteotomy. Clin Orthop Relat Res 2004;418:157–61.
Pajarinen J, Hirvensalo E. Two-incision technique for rotational acetabular osteotomy: Good outcome in 35 hips. Acta Orthop Scand 2003;74:133–9.
Wall EJ, Kolata R, Roy DR, Mehlman CT, Crawford AH. Endoscopic pelvic osteotomy for the treatment of hip dysplasia. J Am Acad Orthop Surg 2001;9:150–6.
Bernstein P, Thielemann F, Günther KP. A modification of periacetabular osteotomy using a two-incision approach. Open Orthop J 2007;1:13–8.
Bilgili F, Gürses IA, Ökaya U, Gayretli Ö, Parmaksizoglu AS, Cetiner Kale A. Ischial and pubic osteotomies performed by medial approach during periacetabular osteotomies: An anatomical study. Acta Orthop Traumatol Turc 2013;47:43–7.
Inan M, Gokce A, Ustunkan F. Endoscopy-assisted periacetabular osteotomy: A preliminary cadaveric study. Clin Orthop Relat Res 2008;466:862–70.
Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique. J Bone Joint Surg Am 2006;88 Suppl 1 Pt 1:65–83.
Davey JP, Santore RF. Complications of periacetabular osteotomy. Clin Orthop Relat Res 1999;363:3–7.
Shiramizu K. Curved periacetabular osteotomy for the dysplastic hip: Cadaveric and radiological analyses of safe procedures. J Orthop Traumatol 2003;4:55–60.
Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of acetabulum fractures through the modified Stoppa approach: Strategies and outcomes. Clin Orthop Relat Res 2014;472:3345–52.
Kinoshita K, Naito M, Shiramizu K, Shiramizu K, Kamada S. Prevention of obturator artery injury during pubic osteotomy in periacetabular osteotomy. Curr Orthop Pract 2011;22:171–5.
Kamada S, Naito M, Shiramizu K, Nakamura Y, Kinoshita K. Is the obturator artery safe when performing ischial osteotomy during periacetabular osteotomy?. Int Orthop 2011;35:503–6.
Kiyama T, Naito M, Shiramizu K, Shinoda T, Maeyama A. Ischemia of the lateral femoral cutaneous nerve during periacetabular osteotomy using Smith-Petersen approach. J Orthop Traumatol 2009;10:123–6.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
About this article
Cite this article
Akgul, T., Coskun, O., Korkmaz, M. et al. A Minimally Invasive Technique Using a Modified Stoppa Approach for Periacetabular Osteotomy: A Preliminary Cadaveric Study. IJOO 51, 687–691 (2017). https://doi.org/10.4103/ortho.IJOrtho_204_16
Published:
Issue Date:
DOI: https://doi.org/10.4103/ortho.IJOrtho_204_16