Mid-term effectiveness of periacetabular osteotomy through modified ilioinguinal approach for acetabular dysplasia in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Renzhi , ZHU Zhaochen ,  XIE Zongping

Department of Orthopedics, the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China;

Corresponding author：

XIE Zongping, Email: x91034@qq.com

Keywords：

Acetabular dysplasia; periacetabular osteotomy; modified ilioinguinal approach; osteoarthritis; adult

DOI：

10.7507/1002-1892.202104110

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Objective To investigate the mid-term effectiveness of periacetabular osteotomy (PAO) through modified ilioinguinal approach for acetabular dysplasia in adults. Methods Between January 2016 and December 2018, 39 patients (43 hips) with acetabular dysplasia who met the selection criteria were enrolled in the study and their clinical data were retrospectively analyzed. All patients were treated with PAO via modified ilioinguinal approach (firstly, the skin and superficial facia were cut via the traditional ilioinguinal approach, and the deep tissues were cut via the modified iliac-femoral approach). There were 3 males (3 hips) and 36 females (40 hips) with an average age of 36 years (range, 18-51 years). Among them, 35 cases of lesions involved single hip and 4 cases of lesions involved bilateral hips. The disease duration ranged from 4 to 96 months, with a median of 18 months. According to the modified Tönnis grading for osteoarthritis, 35 hips were classified as grade 0, 6 hips as grade Ⅰ, and 2 hips as grade Ⅱ. All patients had different degrees of hip pain. The preoperative visual analogue scale (VAS) score of pain was 4.7±0.8, and the modified Harris hip score was 78.5±8.6. The lateral centre-edge angle (LCEA) was (10.52±10.83)°, and the acetabular index (AI) was (26.89±9.07) °. The operation time, intraoperative blood loss, and the incidence of complications were recorded. LCEA, AI, and the progression of osteoarthritis were reviewed by X-ray films. The function and pain of hip joint were evaluated by modified Harris hip score and VAS score. Results All operations were successfully completed. The operation time was 90-150 minutes, with an average of 130 minutes. The volume of intraoperative blood loss was 350-600 mL, with an average of 500.6 mL. All patients were followed up 17-52 months, with an average of 32.7 months. Postoperative numbness of the lateral femoral cutaneous nerve occurred in 3 cases, and no other complications occurred. At last follow-up, the modified Harris hip score was 97.7±3.7 and VAS score was 0.9±1.1, both of which were better than those before operation (P<0.05). At 1 year after operation, X-ray films showed that the all osteotomies healed. In term of the modified Tönnis grading for osteoarthritis, 1 hip downgraded from grade 1 to grade 0, while the remaining hips stayed unchanged. At last follow-up, LCEA and AI were (27.54±8.49) ° and (11.30±5.53) °, respectively, which were significantly different from those before operation (P<0.05). Conclusion PAO through modified ilioinguinal approach is effective in relieving pain and restoring hip function in adults with acetabular dysplasia, which can overcome the disadvantages of the traditional ilioinguinal approach, and may delay the development of osteoarthritis.

Citation： GAO Renzhi, ZHU Zhaochen, XIE Zongping. Mid-term effectiveness of periacetabular osteotomy through modified ilioinguinal approach for acetabular dysplasia in adults. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1100-1104. doi: 10.7507/1002-1892.202104110 Copy

1.	Kalore NV, Cheppalli SP, Daner WE, et al. Acetabular dysplasia in middle-aged patients: periacetabular osteotomy or total hip arthroplasty? J Arthroplasty, 2016, 31(9): 1894-1898.
2.	Nunley RM, Prather H, Hunt D, et al. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg (Am), 2011, 93 Suppl 2: 17-21.
3.	Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res, 1988, (232): 26-36.
4.	Luo R, Li G, Li B, et al. Comparison of the modified Smith-Petersen (S-P) and ilioinguinal (I-I) approaches for periacetabular osteotomy in adult developmental dysplasia of the hip: a retrospective study. J Orthop Surg Res, 2021, 16(1): 157. doi: 10.1186/s13018-021-02255-2.
5.	Luo D, Zhang H, Zhang W. Comparison of three approaches of Bernese periacetabular osteotomy. Ther Clin Risk Manag, 2016, 12: 67-72.
6.	Garras DN, Crowder TT, Olson SA. Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg (Br), 2007, 89(6): 721-724.
7.	Hofmann S, Tschauner Ch, Graf R. Mechanical causes of osteoarthritis in young adults. Hip Int, 2003, 13(1): 3-9.
8.	Brand RA. Hip osteotomies: a biomechanical consideration. J Am Acad Orthop Surg, 1997, 5(5): 282-291.
9.	Ninomiya S. Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult. Clin Orthop Relat Res, 1989, (247): 127-137.
10.	Ali M, Malviya A. Complications and outcome after periacetabular osteotomy-influence of surgical approach. Hip Int, 2020, 30(1): 4-15.
11.	Kamath AF. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications. World J Orthop, 2016, 7(5): 280-286.
12.	Clohisy JC, Barrett SE, Gordon JE, et al. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique. J Bone Joint Surg (Am), 2006, 88 Suppl 1 Pt 1: 65-83.
13.	Matheney T, Zaltz I, Kim YJ, et al. Activity level and severity of dysplasia predict age at bernese periacetabular osteotomy for symptomatic hip dysplasia. J Bone Joint Surg (Am), 2016, 98(8): 665-671.
14.	Wells J, Millis M, Kim YJ, et al. Survivorship of the bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res, 2017, 475(2): 396-405.
15.	Schmitz MR, Murtha AS, Clohisy JC, et al. Developmental dysplasia of the hip in adolescents and young adults. J Am Acad Orthop Surg, 2020, 28(3): 91-101.
16.	Pascual-Garrido C, Harris MD, Clohisy JC. Innovations in joint preservation procedures for the dysplastic hip “the periacetabular osteotomy”. J Arthroplasty, 2017, 32(9S): S32-S37.
17.	黄野, 张洪, 徐辉, 等. 经髂腹股沟入路伯尔尼髋臼周围截骨术的中期随访. 中华骨科杂志, 2007, 27(7): 499-504.
18.	Lerch TD, Steppacher SD, Liechti EF, et al. One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res, 2017, 475(4): 1154-1168.

1. Kalore NV, Cheppalli SP, Daner WE, et al. Acetabular dysplasia in middle-aged patients: periacetabular osteotomy or total hip arthroplasty? J Arthroplasty, 2016, 31(9): 1894-1898.
2. Nunley RM, Prather H, Hunt D, et al. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg (Am), 2011, 93 Suppl 2: 17-21.
3. Ganz R, Klaue K, Vinh TS, et al. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res, 1988, (232): 26-36.
4. Luo R, Li G, Li B, et al. Comparison of the modified Smith-Petersen (S-P) and ilioinguinal (I-I) approaches for periacetabular osteotomy in adult developmental dysplasia of the hip: a retrospective study. J Orthop Surg Res, 2021, 16(1): 157. doi: 10.1186/s13018-021-02255-2.
5. Luo D, Zhang H, Zhang W. Comparison of three approaches of Bernese periacetabular osteotomy. Ther Clin Risk Manag, 2016, 12: 67-72.
6. Garras DN, Crowder TT, Olson SA. Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg (Br), 2007, 89(6): 721-724.
7. Hofmann S, Tschauner Ch, Graf R. Mechanical causes of osteoarthritis in young adults. Hip Int, 2003, 13(1): 3-9.
8. Brand RA. Hip osteotomies: a biomechanical consideration. J Am Acad Orthop Surg, 1997, 5(5): 282-291.
9. Ninomiya S. Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult. Clin Orthop Relat Res, 1989, (247): 127-137.
10. Ali M, Malviya A. Complications and outcome after periacetabular osteotomy-influence of surgical approach. Hip Int, 2020, 30(1): 4-15.
11. Kamath AF. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications. World J Orthop, 2016, 7(5): 280-286.
12. Clohisy JC, Barrett SE, Gordon JE, et al. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique. J Bone Joint Surg (Am), 2006, 88 Suppl 1 Pt 1: 65-83.
13. Matheney T, Zaltz I, Kim YJ, et al. Activity level and severity of dysplasia predict age at bernese periacetabular osteotomy for symptomatic hip dysplasia. J Bone Joint Surg (Am), 2016, 98(8): 665-671.
14. Wells J, Millis M, Kim YJ, et al. Survivorship of the bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res, 2017, 475(2): 396-405.
15. Schmitz MR, Murtha AS, Clohisy JC, et al. Developmental dysplasia of the hip in adolescents and young adults. J Am Acad Orthop Surg, 2020, 28(3): 91-101.
16. Pascual-Garrido C, Harris MD, Clohisy JC. Innovations in joint preservation procedures for the dysplastic hip “the periacetabular osteotomy”. J Arthroplasty, 2017, 32(9S): S32-S37.
17. 黄野, 张洪, 徐辉, 等. 经髂腹股沟入路伯尔尼髋臼周围截骨术的中期随访. 中华骨科杂志, 2007, 27(7): 499-504.
18. Lerch TD, Steppacher SD, Liechti EF, et al. One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res, 2017, 475(4): 1154-1168.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of periacetabular osteotomy through modified ilioinguinal approach for acetabular dysplasia in adults

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