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Bernese Peri-acetabular Osteotomy

  • Christopher Dowding
  • Paul E. Beaulé
Chapter

Abstract

Hip dysplasia is a common pathology that causes significant morbidity in the young adult population. The abnormal morphology of a dysplastic hip results in nonphysiological loading across the acetabular rim and is associated with labral pathology and the development of osteoarthritis. The goal of corrective surgery in the treatment of hip dysplasia is to improve function by redistributing the load across the hip joint, thereby relieving pain and delaying and possibly preventing end-stage arthritis. In the treatment of adult hip dysplasia, the Bernese peri-acetabular osteotomy (PAO) is the most widely accepted technique for the treatment of hip dysplasia. The PAO provides a method for obtaining a large corrective reorientation of the acetabulum with a single incision and without the need for external immobilization. This is accomplished through a reorientation of the acetabulum which medializes the joint center, improves superolateral inclination, and increases femoral head coverage while keeping the pelvic ring intact. Patient selection is critical to identify patients that stand to benefit the most from this procedure. Factors related to a poor outcome are patient age greater than 35, incongruency of the hip joint, and advanced osteoarthritis. Also, an increased alpha angle can help identify those patients who may benefit from a concomitant arthrotomy or hip arthroscopy to treat a cam deformity of the proximal femur and/or repair the labrum. This procedure can also be used to reorient a retroverted acetabulum in patients with symptoms of anterior impingement and decreased internal rotation.

Keywords

Peri-acetabular Hip dysplasia Retroversion Labral tear Pelvic osteotomy 

Reference

  1. 1.
    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):26–36.Google Scholar

Further Reading

  1. Beaulé PE, Dowding C, Parker G, Ryu JJ. What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2015;473(2):615–22.CrossRefGoogle Scholar
  2. Clohisy JC, Schutz AL, St JL, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467(8):2041–52.CrossRefGoogle Scholar
  3. Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009;91(9):2113–23.CrossRefGoogle Scholar
  4. Troelsen A, Elmengaard B, Søballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg. 2009;91(9):2169–79.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Orthopaedic SurgeryUniversity of Ottawa, The Ottawa HospitalOttawaCanada

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