Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications

Abstract

For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

Keywords: Periacetabular osteotomy; Hip dysplasia; Pelvis

Core tip: The periacetabular osteotomy has been used to address structural deformity in young patients with acetabular dysplasia. The technique through a modified Smith-Petersen approach offers advantages: Preservation of the posterior column adds to the stability of the hemipelvis and protection of the sciatic nerve, preservation of the acetabular blood supply, and maintenance of hip abductor musculature. The juxta-articular osteotomy planes offer the ability to effect powerful deformity correction about an ideal center of rotation. While maximizing joint stability, coverage and congruency, the acetabular reorientation must also be assessed in light of the impingement-free range of motion.