Skip to main content

Advertisement

SpringerLink
Log in

Periacetabular osteotomy: a review of swiss experience

  • Modern Techniques in Lower Limb Realignment (DE Bonasia and P Phisitkul, Section Editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Symptomatic dysplasia of the hip and acetabular retroversion are possible causes of osteoarthritis in the young adult. Surgical management with reorientation of the acetabulum allows causal therapy of the deformity and preservation of the native hip joint. The Ganz' periacetabular osteotomy permits a free 3-dimensional reorientation of the acetabulum and respects the blood supply of the acetabular fragment. The posterior column remains intact with a stable fixation of the acetabular fragment and a preserved shape of the true pelvis. There is a significant learning curve with severe complications in up to 30 % of cases. Good results can be expected in the long-term follow-up if performed with correct indication at young age in hips with preserved joint cartilage and proper reorientation of the acetabular fragment. Overall survivorship is superior to the natural course of hip dysplasia with a preserved hip joint in 61 % after 20 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Stulberg S. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Cordell LDHW, Ramsey PL, McEwen GD, editors. The hip: proceedings of the third open scientific meeting of the hip society. St. Louis: CV Mosby; 1975. p. 212–28.

    Google Scholar 

  2. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20–33.

    PubMed  Google Scholar 

  3. Solomon L, Schnitzler CM. Pathogenetic types of coxarthrosis and implications for treatment. Arch Orthop Trauma Surg Archiv Orthop Unfall Chir. 1983;101:259–61.

    Article  CAS  Google Scholar 

  4. Ipach I, Mittag F, Syha R, Kunze B, Wolf P, Kluba T. Indications for total hip arthroplasty in young adults—idiopathic osteoarthritis seems to be overestimated. RöFo. 2012;184:239–47.

    PubMed  CAS  Google Scholar 

  5. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–9.

    PubMed  CAS  Google Scholar 

  6. Hasegawa Y. Natural course of coxarthrosis in dysplastic hips. Orthopade. 1994;23:185–90.

    PubMed  CAS  Google Scholar 

  7. Lane NE, Lin P, Christiansen L, Gore LR, Williams EN, Hochberg MC, et al. Association of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elderly white women: the study of osteoporotic fractures. Arthritis Rheum. 2000;43:400–4.

    Article  PubMed  CAS  Google Scholar 

  8. Ziegler J, Thielemann F, Mayer-Athenstaedt C, Gunther KP. The natural history of developmental dysplasia of the hip. A meta-analysis of the published literature. Orthopade. 2008;37(515–6):8–24.

    Google Scholar 

  9. Wedge JH, Wasylenko MJ. The natural history of congenital disease of the hip. J Bone Joint Surg (Br). 1979;61-B:334–8.

    CAS  Google Scholar 

  10. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg (Br). 1991;73:423–9.

    CAS  Google Scholar 

  11. Chiari K. Medial displacement osteotomy of the pelvis. Clin Orthop Relat Res. 1974;98:55–71.

    Article  PubMed  Google Scholar 

  12. Lance M. Constitution d'une butée ostéoplastique dans les luxations et subluxations congénitales de la hanche. Presse Med. 1925;33:945–8.

    Google Scholar 

  13. Spitzy H. Artificial acetabular roof: osseous bolts for temporary fixation. Z Orthop Chir. 1923;43:284–94.

    Google Scholar 

  14. Colonna P. Congenital dislocation of the hip in older subjects: based on a study of sixty-six open operations. J Bone Joint Surg. 1953;14:227–98.

    Google Scholar 

  15. Codivilla A. The operative treatment of congenital dislocations. N Y Med J. 1902;73:741.

    Google Scholar 

  16. Ganz R, Slongo T, Siebenrock KA, Turchetto L, Leunig M. Surgical technique: the capsular arthroplasty: a useful but abandoned procedure for young patients with developmental dysplasia of the hip. Clin Orthop Relat Res. 2012;470:2957–67.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ninomiya S. Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult. Clin Orthop Relat Res. 1989;247:127–37.

    PubMed  Google Scholar 

  18. Wagner H. Osteotomies for congenital hip dislocation. In: The Hip Proceedings of the Fourth Open Scientific Meeting of The Hip Society. St. Louis: CV Mosby; 1976. p. 45–66.

  19. Schramm M, Hohmann D, Radespiel-Troger M, Pitto RP. Treatment of the dysplastic acetabulum with Wagner spherical osteotomy. A study of patients followed for a minimum of twenty years. J Bone Joint Surg Am. 2003;85-A:808–14.

    PubMed  Google Scholar 

  20. Itokazu M, Takahashi K, Matsunaga T, Hayakawa D, Emura S, Isono H, et al. A study of the arterial supply of the human acetabulum using a corrosion casting method. Clin Anat. 1997;10:77–81.

    Article  PubMed  CAS  Google Scholar 

  21. Tonnis D, Behrens K, Tscharani F. A modified technique of the triple pelvic osteotomy: early results. J Pediat Orthop. 1981;1:241–9.

    Article  CAS  Google Scholar 

  22. 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.

    PubMed  Google Scholar 

  23. Leunig M, Siebenrock KA, Ganz R. Rationale of periacetabular osteotomy and background work. Instr Course Lect. 2001;50:229–38.

    PubMed  CAS  Google Scholar 

  24. Beck M, Leunig M, Ellis T, Sledge JB, Ganz R. The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat. 2003;25:361–7.

    Article  PubMed  CAS  Google Scholar 

  25. Fluckiger G, Eggli S, Kosina J, Ganz R. Birth after peri-acetabular osteotomy. Orthopade. 2000;29:63–7.

    PubMed  CAS  Google Scholar 

  26. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–44. Important paper presenting the 20 year results of the original technique of the first 75 cases. It shows that excellent results can be expected after 20 years, if initally the cartilage damage is limited. It's a proof of concept of the reorientation preocedure.

  27. van Hellemondt GG, Sonneveld H, Schreuder MH, Kooijman MA, de Kleuver M. Triple osteotomy of the pelvis for acetabular dysplasia: results at a mean follow-up of 15 years. J Bone Joint Surg (Br). 2005;87:911–5.

    Article  Google Scholar 

  28. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85-A:278–86.

    PubMed  CAS  Google Scholar 

  29. Leunig M, Nho SJ, Turchetto L, Ganz R. Protrusio acetabuli: new insights and experience with joint preservation. Clin Orthop Relat Res. 2009;467:2241–50.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Clohisy JC, Ross JR, North JD, Nepple JJ, Schoenecker PL. What are the factors associated with acetabular correction in Perthes-like hip deformities? Clin Orthop Relat Res. 2012;470:3439–45.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am. 2005;87:254–9.

    Article  PubMed  Google Scholar 

  32. Clohisy JC, St John LC, Nunley RM, Schutz AL, Schoenecker PL. Combined periacetabular and femoral osteotomies for severe hip deformities. Clin Orthop Relat Res. 2009;467:2221–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. Am J Roentgenol. 2007;188:1540–52.

    Article  Google Scholar 

  34. Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, et al. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–90.

    Article  PubMed  CAS  Google Scholar 

  35. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39–47.

    PubMed  Google Scholar 

  36. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand. 1939:5–135.

  37. Kleinberg S. The Acetabular Index in infants in relation to congenital dislocation of the hip. Arch Surg. 1936;32:1049.

    Article  Google Scholar 

  38. Lequesne M. Coxometry. measurement of the basic angles of the adult radiographic hip by a combined protractor. Rev Rhum Mal Osteo Articulaires. 1963;30:479–85.

    CAS  Google Scholar 

  39. Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin: Springer; 1987.

    Book  Google Scholar 

  40. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg (Br). 1999;81:281–8.

    Article  CAS  Google Scholar 

  41. Larson AN, Stans AA, Sierra RJ. Ischial spine sign reveals acetabular retroversion in Legg-Calve-Perthes disease. Clin Orthop Relat Res. 2011;469:2012–8.

    Article  PubMed  Google Scholar 

  42. Siebenrock KA, Kistler L, Schwab JM, Buchler L, Tannast M. The acetabular wall index for assessing anteroposterior femoral head coverage in symptomatic patients. Clin Orthop Relat Res. 2012;470:3355–60.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Shenton E. A diagnostic line about the hip joint. Paper read to the British Electrotherapeutic Society, 10 January 1902, in the rooms of The Medical Society of London. J Phys Ther. 1902;3:110–2.

    Google Scholar 

  44. Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg (Br). 2002;84:556–60.

    Article  CAS  Google Scholar 

  45. de Lequesne MS. False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies. Rev Rhum Mal Osteo Articulaires. 1961;28:643–52.

    CAS  Google Scholar 

  46. Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011;469:1728–34.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  47. Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949;31A:40–6.

    PubMed  CAS  Google Scholar 

  48. Tannast M, Kakaty DK, Zheng G, Siebenrock KA. What is a normal acetabulum? A computer-assisted radiographic study. In: Davies BL, Joskowicz L, Murphy SB, editors. Computer assisted orthopaedic surgery. Berlin: Pro Business; 2009. p. 254–7.

    Google Scholar 

  49. Millis MB, Siebenrock KA, Session P. Report of breakout session: defining parameters for correcting the acetabulum during a pelvic reorientation osteotomy. Clin Orthop Relat Res. 2012;470:3453–5. This expert summary briefly highlights the important parameters to be looked at for optimal positioning of the acetabular fragment during PAO.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.

    Article  PubMed  Google Scholar 

  51. Ziebarth K, Balakumar J, Domayer S, Kim YJ, Millis MB. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res. 2011;469:447–53.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  52. Albers CE, Steppacher SD, Ganz R, Tannast M, Siebenrock KA. Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res. 2013;471:1602–14. Very important outcome paper analyzing variuos parameters. The analysis includes patient and surgeon related factors and analyses the quality of acetabular correction.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Sierra RJ, Beaule P, Zaltz I, Millis MB, Clohisy JC, Trousdale RT, et al. Prevention of nerve injury after periacetabular osteotomy. Clin Orthop Relat Res. 2012;470:2209–19.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Siebenrock KA, Steppacher SD, Albers CE, Haefeli PC, Tannast M. Diagnosis and management of developmental dysplasia of the hip from triradiate closure through young adulthood. J Bone Joint Surg Am. 2013;95:748–55.

    PubMed  Google Scholar 

  55. Whittingham-Jones P, Kirit Patel N, Hashemi-Nejad A. The Bernese peri-acetabular osteotomy through a modified approach. A technical note. J Child Orthop. 2013;7:107–10.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Troelsen A, Elmengaard B, Soballe K. A new minimally invasive transsartorial approach for periacetabular osteotomy. J Bone Joint Surg Am. 2008;90:493–8.

    Article  PubMed  CAS  Google Scholar 

  57. Ross JR, Zaltz I, Nepple JJ, Schoenecker PL, Clohisy JC. Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia. Am J Sports Med. 2011;39(Suppl):72S–8.

    Article  PubMed  Google Scholar 

  58. Hsieh PH, Chang YH, Shih CH. Image-guided periacetabular osteotomy: computer-assisted navigation compared with the conventional technique: a randomized study of 36 patients followed for 2 years. Acta Orthop. 2006;77:591–7.

    Article  PubMed  Google Scholar 

  59. Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am. 2006;88:1920–6.

    Article  PubMed  Google Scholar 

  60. Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am. 2007;89:1417–23.

    Article  PubMed  Google Scholar 

  61. Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467:2041–52.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Hussell JG, Rodriguez JA, Ganz R. Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:81–92. Good overview of complications occuring during the execution of PAO.

    PubMed  Google Scholar 

  63. Murphy S, Deshmukh R. Periacetabular osteotomy: preoperative radiographic predictors of outcome. Clin Orthop Relat Res. 2002;405:168–74.

    Article  PubMed  Google Scholar 

  64. Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am. 1995;77:73–85.

    PubMed  CAS  Google Scholar 

  65. 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;91:2113–23. Independent analysis of outcome factors after PAO and predictors of clinical outcome.

    Article  PubMed  Google Scholar 

  66. Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V. The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7–15-year follow-up of 26 hips. Acta Orthop. 2005;76:833–40.

    Article  PubMed  Google Scholar 

  67. Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am. 2009;91:2169–79.

    Article  PubMed  Google Scholar 

  68. Ito H, Tanino H, Yamanaka Y, Minami A, Matsuno T. Intermediate to long-term results of periacetabular osteotomy in patients younger and older than forty years of age. J Bone Joint Surg Am. 2011;93:1347–54.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Lorenz Büchler and Martin Beck declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

Author information

Authors and Affiliations

  1. Clinic for Orthopaedic and Trauma Surgery, Spitalzentrum Biel, 2501, Biel, Switzerland

    Lorenz Büchler

  2. Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, 6000, Luzern, Switzerland

    Martin Beck

Authors
  1. Lorenz Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenz Büchler.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Büchler, L., Beck, M. Periacetabular osteotomy: a review of swiss experience. Curr Rev Musculoskelet Med 7, 330–336 (2014). https://doi.org/10.1007/s12178-014-9232-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-014-9232-0

Keywords

Search

Navigation