Surgical Approach for Periacetabular Osteotomy

Reference work entry

Abstract

The surgical technique for the Bernese periacetabular osteotomy was developed by Prof. Reinhold Ganz in 1984 for the treatment of hip dysplasia (Ganz R, Klaue K, Vinh TS, Mast JW. Clin Orthop Rel Res 232:26–36, 1988). The purpose of the surgical approach is to expose the innominate bone in order to enable an osteotomy which allows for a complete detachment of the acetabulum while leaving the posterior 50 % of the posterior column intact. The dissection resembles the well-known Smith-Petersen approach with a few modifications. Anatomical structures at risk during surgical exposure and osteotomy include the lateral femoral cutaneous nerve, the femoral nerve, the sciatic nerve, the obturator artery and nerve, and the medial femoral circumflex artery. This chapter describes in detail the surgical setup, the planes of dissection, the location of the neurovascular structure at risk, and how to avoid complications.

Keywords

Catheter Adduct Crest Mast Osteonecrosis 

References

  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 Rel Res. 1988;232:26–36.Google Scholar
  2. 2.
    Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Jt Surg. 1949;31A(1):40–6.Google Scholar
  3. 3.
    Hussell JG, Rodriguez JA, Ganz R. Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Rel Res. 1999;363:81–92.Google Scholar
  4. 4.
    Leunig M, Ganz R. Evolution of technique and indications for the Bernese periacetabular osteotomy. Bull NYU Hosp Jt Dis. 2011;69(Suppl 1):S42–6.Google Scholar
  5. 5.
    Hempfing A, Leunig M, Notzli HP, Beck M, Ganz R. Acetabular blood flow during Bernese periacetabular osteotomy: an intraoperative study using laser Doppler flowmetry. J Orthop Res. 2003;21(6):1145–50.PubMedCrossRefGoogle Scholar
  6. 6.
    Beck M, Leunig M, Ellis T, Sledge JB, Ganz R. The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat. 2003;25(5–6):361–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Nogler M. The direct anterior approach to the hip. Mahwah: HSC Press; 2011.Google Scholar
  8. 8.
    Ward WT, Fleisch ID, Ganz R. Anatomy of the iliocapsularis muscle. Relevance to surgery of the hip. Clin Orthop Rel Res. 2000;374:278–85.CrossRefGoogle Scholar
  9. 9.
    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(4):503–6.Google Scholar
  10. 10.
    Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Jt Surg Br. 2000;82(5):679–83.CrossRefGoogle Scholar
  11. 11.
    Sierra RJ, Beaule P, Zaltz I, Millis MB, Clohisy JC, Trousdale RT. Prevention of nerve injury after periacetabular osteotomy. Clin Orthop Rel Res. 2012;470(8):2209–19.Google Scholar
  12. 12.
    Pring ME, Trousdale RT, Cabanela ME, Harper CM. Intraoperative electromyographic monitoring during periacetabular osteotomy. Clin Orthop Rel Res. 2002;400:158–64.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryIndiana University School of Medicine, IU Health Methodist HospitalIndianapolisUSA

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