Dataset Information

Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO.

ABSTRACT: In this Technical Note, we discuss the combined hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of symptomatic hip dysplasia, with a focus on the technique we use for the PAO. We identify modifications that can be made during the arthroscopic portion of the procedure to assist in the PAO dissection, including arthroscopic capsular closure and arthroscopic elevation of the iliocapsularis muscle off the capsule, which allows for expedited open exposure during the PAO.

SUBMITTER: Spiker AM

PROVIDER: S-EPMC8556612 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO.

Spiker Andrea M AM Turner Elizabeth H G EHG Gans Itai I Sisel Haley I HI Wiseley Benjamin R BR Goodspeed David C DC

Arthroscopy techniques 20210921 10

In this Technical Note, we discuss the combined hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of symptomatic hip dysplasia, with a focus on the technique we use for the PAO. We identify modifications that can be made during the arthroscopic portion of the procedure to assist in the PAO dissection, including arthroscopic capsular closure and arthroscopic elevation of the iliocapsularis muscle off the capsule, which allows for expedited open exposure during the PAO. ...[more]

PMID: 34754737

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Project description:BackgroundHip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed.PurposeIn adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy.MethodsA comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures.ResultsFrom 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia.ConclusionsBefore undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants.RegistrationPROSPERO (CRD42020144748).

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 (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO.

Publications

Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO.

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