International Orthopaedics

, Volume 40, Issue 7, pp 1389–1396 | Cite as

Periacetabular osteotomy through the pararectus approach: technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment

  • Li Liu
  • Guoyan Zheng
  • Johannes Dominik Bastian
  • Marius Johann Baptist Keel
  • Lutz Peter Nolte
  • Klaus Arno Siebenrock
  • Timo Michael Ecker
Original Paper

Abstract

Purpose

The pararectus approach has been validated for managing acetabular fractures. We hypothesised it might be an alternative approach for performing periacetabular osteotomy (PAO).

Methods

Using four cadaver specimens, we randomly performed PAO through either the pararectus or a modified Smith-Petersen (SP) approach. We assessed technical feasibility and safety. Furthermore, we controlled fragment mobility using a surgical navigation system and compared mobility between approaches. The navigation system’s accuracy was tested by cross-examination with validated preoperative planning software.

Results

The pararectus approach is technically feasible, allowing for adequate exposure, safe osteotomies and excellent control of structures at risk. Fragment mobility is equal to that achieved through the SP approach. Validation of these measurements yielded a mean difference of less <1 mm without statistical significance.

Conclusion

Experimental data suggests the pararectus approach might be an alternative approach for performing PAO. Clinical validation is necessary to confirm these promising preliminary results.

Keywords

Pelvis Osteotomy Pararectus approach Surgical navigation Joint preservation Hip 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and IRB approval

All studies were approved by the appropriate institutional and/or national research ethics committee and were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

References

  1. 1.
    Ganz R, Klaue K, Vinh TS, Mast JW (1988) A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 232(232):26–36PubMedGoogle Scholar
  2. 2.
    Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL (2005) Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am 87(2):254–259CrossRefPubMedGoogle Scholar
  3. 3.
    Hussell JG, Mast JW, Mayo KA, Howie DW, Ganz R (1999) A comparison of different surgical approaches for the periacetabular osteotomy. Clin Orthop Relat Res 363:64–72PubMedGoogle Scholar
  4. 4.
    Matta JM, Stover MD, Siebenrock K (1999) Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res 363:21–32PubMedGoogle Scholar
  5. 5.
    Siebenrock KA, Scholl E, Lottenbach M, Ganz R (1999) Bernese periacetabular osteotomy. Clin Orthop Relat Res 363(363):9–20PubMedGoogle Scholar
  6. 6.
    Troelsen A, Elmengaard B, Soballe K (2008) Comparison of the minimally invasive and ilioinguinal approaches for periacetabular osteotomy: 263 single-surgeon procedures in well-defined study groups. Acta Orthop 79(6):777–784CrossRefPubMedGoogle Scholar
  7. 7.
    Troelsen A, Elmengaard B, Soballe K (2008) A new minimally invasive transsartorial approach for periacetabular osteotomy. J Bone Joint Surg Am 90(3):493–498CrossRefPubMedGoogle Scholar
  8. 8.
    Albers CE, Steppacher SD, Ganz R, Tannast M, Siebenrock KA (2013) Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH. Clin Orthop Relat ResGoogle Scholar
  9. 9.
    Clohisy JC, Schutz AL, John LS, Schoenecker PL, Wright RW (2009) Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res 467(8):2041–2052CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hussell JG, Rodriguez JA, Ganz R (1999) Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res 363(363):81–92PubMedGoogle Scholar
  11. 11.
    Davey JP, Santore RF (1999) Complications of periacetabular osteotomy. Clin Orthop Relat Res 363(363):33–37PubMedGoogle Scholar
  12. 12.
    Keel MJ, Ecker TM, Cullmann JL, Bergmann M, Bonel HM, Buchler L, Siebenrock KA, Bastian JD (2012) The pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg (Br) 94(3):405–411CrossRefGoogle Scholar
  13. 13.
    Liu L, Ecker T, Schumann S, Siebenrock K, Nolte L, Zheng G (2014) Computer assisted planning and navigation of periacetabular osteotomy with range of motion optimization. Med Image Comput Comput Assist Interv 17(Pt 2):643–650PubMedGoogle Scholar
  14. 14.
    Puls M, Ecker TM, Steppacher SD, Tannast M, Siebenrock KA, Kowal JH (2011) Automated Detection of the Acetabular Rim Using Three-dimensional Models of the Pelvis. Comput Biol Med. article in pressGoogle Scholar
  15. 15.
    Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg (Br) 75(2):228–232Google Scholar
  16. 16.
    Lavallee S (1996) Registration for computer-integrated surgery: methodology, state of the art. Comput Integr Surg 5(5):77–97Google Scholar
  17. 17.
    Keel MJ, Tomagra S, Bonel HM, Siebenrock KA, Bastian JD (2014) Clinical results of acetabular fracture management with the pararectus approach. Injury 45(12):1900–1907CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2015

Authors and Affiliations

  • Li Liu
    • 1
  • Guoyan Zheng
    • 1
  • Johannes Dominik Bastian
    • 2
  • Marius Johann Baptist Keel
    • 1
  • Lutz Peter Nolte
    • 1
  • Klaus Arno Siebenrock
    • 2
  • Timo Michael Ecker
    • 2
  1. 1.Institute for Surgical Technology and BiomechanicsUniversity of BerneBernSwitzerland
  2. 2.Department of Orthopaedic Surgery, InselspitalUniversity of BerneBernSwitzerland

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