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Combined hip arthroscopy and periacetabular osteotomy: indications, advantages, technique, and complications.

ABSTRACT: Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are outlined.

SUBMITTER: Domb BG

PROVIDER: S-EPMC4017955 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Combined hip arthroscopy and periacetabular osteotomy: indications, advantages, technique, and complications.

Domb Benjamin G BG LaReau Justin J Redmond John M JM

Arthroscopy techniques 20140110 1

Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are ou ...[more]

PMID: 24843847

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Project description:Combined hip arthroscopy and periacetabular osteotomy are used for the treatment of concomitant intra-articular hip pathology and acetabular dysplasia or instability. Traditionally, the procedure has been achieved with the use of a traction table or table attachment for the arthroscopic portion and then subsequent transfer of the patient to a fully radiolucent flat bed. In this article, we highlight the technique of a combined hip arthroscopy and periacetabular osteotomy procedure using a single bed attachment system. Technique Video Video 1 Step-by-step demonstration of a combined hip arthroscopy with labral repair and femoral acetabular osteochondroplasty with subsequent periacetabular osteotomy performed on a single radiolucent traction table without a perineal post in a patient with femooracetabular impingement in the setting of hip dysplasia of the patient's right hip. Standard arthroscopy portals are created and an interportal arthrotomy is created between the modified midanterior (MMA) portal and the anterolateral (AL) portal. While viewing through the AL portal, the labrum is debrided through the MMA portal and suture anchors are placed through the distal anterolateral accessory (DALA) portal. A capsular retention suture is then placed through the DALA to retract the inferior capsule to obtain better visualization of the femoral neck, and an osteochondroplasty is performed. The retention suture is removed, and the capsule is closed. Once the hip arthroscopy portion is complete, the periacetabular osteotomy is begun on the same operative table. A bikini-line incision is made along the inguinal crease of the hip. The superior pubic ramus cut is made with the use of an osteotome. An interval is created between the medial femoral neck and the iliopsoas tendon to gain access for the ischial osteotomy. Finally, the iliac osteotomy is performed parallel to the roof of the acetabulum and connected to the ischial osteotomy site with the use of a curved, tined osteotome, with care taken to preserve the posterior column. A Schanz pin is then placed in the osteotomized portion of the acetabulum and used to manipulate the free fragment with the assistance of additional manipulation and traction of the lower extremity from the traction table to provide adequate hip joint coverage. Once the dysplasia has been corrected, the periacetabular osteotomy is fixed into place with four solid 4.5-mm stainless steel screws.

Dataset Information

Combined hip arthroscopy and periacetabular osteotomy: indications, advantages, technique, and complications.

Publications

Combined hip arthroscopy and periacetabular osteotomy: indications, advantages, technique, and complications.

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