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Prevention of Nerve Injury After Periacetabular Osteotomy

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

Abstract

Background

The Bernese periacetabular osteotomy (PAO) is the preferred pelvic osteotomy in many centers treating symptomatic acetabular dysplasia in the young adult. Major nerve injury has been reported as a complication that can occur with this complex procedure, but the incidence and circumstances associated with such injury are not well known.

Questions/Purposes

We asked: (1) What is the incidence of sciatic and femoral nerve injury after PAO; (2) what are the risk factors associated with such injury; and (3) what are the consequences of such injury including the degree of neurologic recovery?

Patients and Methods

We identified 1760 PAOs that were performed between 1991 and 2008 at five institutions. A major nerve injury was defined as a postoperative motor nerve palsy or sensory deficit present after surgery in the distribution of the femoral or sciatic nerves. Risk factors associated with nerve injury and the treatment and degree of neurologic recovery were reviewed from medical records.

Results

Thirty-six of the 1760 patients (2.1%) had a major nerve deficit of the sciatic or femoral nerve develop. We identified no patient or surgical risk factor associated with the occurrence of nerve injury. Seventeen of the 36 patients had complete recovery. The median time to recovery or plateau was 5.5 months (range, 2 days to 24 months).

Conclusions

The incidence of sciatic and femoral nerve injury during PAO is less than previously reported. Full recovery can be expected in only ½ of the patients and more commonly with injuries of the femoral nerve. If direct nerve injury is suspected, we believe exploration may be warranted.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Perry Schoenecker MD and Young Jo-Kim MD for contributing cases for this study.

Author information

Authors and Affiliations

  1. Mayo Clinic, Orthopedic Surgery, 200 First Street SW, Rochester, MN, 55905, USA

    Rafael J. Sierra MD & Robert T. Trousdale MD

  2. Division of Orthopedic Surgery, Adult Reconstruction Service, Ottawa General Hospital, Ottawa, Canada

    Paul Beaule MD

  3. William Beaumont Hospital, Detroit, MI, USA

    Ira Zaltz MD

  4. Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA

    Michael B. Millis MD

  5. Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO, USA

    John C. Clohisy MD

Authors
  1. Rafael J. Sierra MD
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  2. Paul Beaule MD
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  3. Ira Zaltz MD
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  4. Michael B. Millis MD
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  5. John C. Clohisy MD
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  6. Robert T. Trousdale MD
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Corresponding author

Correspondence to Rafael J. Sierra MD.

Additional information

In addition to the authors, Perry Schoenecker MD and Young Jo-Kim MD comprise the ANCHOR group.

One of the authors (RJS) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of $10,000 from Biomet Inc (Warsaw, IN). One of the authors (JCC) certifies he has or may receive payments or benefits, in any one year, an amount of less than $10,000 from Biomet Inc. One of the authors (RTT) certifies he has or may receive payments or benefits, in any one year, an amount in excess of $100,000 from DePuy, Warsaw, IN, USA, and less than $10,000 from MAKO Surgical Corp., Ft. Lauderdale, FL, USA, and Wright Medical, Arlington, TN, USA.

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 work was performed at the Mayo Clinic, Rochester, MN, USA.

Appendix 1. Nerve Injury after PAO Data Collection Sheet

Appendix 1. Nerve Injury after PAO Data Collection Sheet

 

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Sierra, R.J., Beaule, P., Zaltz, I. et al. Prevention of Nerve Injury After Periacetabular Osteotomy. Clin Orthop Relat Res 470, 2209–2219 (2012). https://doi.org/10.1007/s11999-012-2409-1

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  • DOI: https://doi.org/10.1007/s11999-012-2409-1

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