FOUR YEAR EXPERIENCE WITH THE KINGSTON PERIACETABULAR OSTEOTOMY: A NOVEL COMPUTER-ASSISTED TECHNIQUE

Abstract

Periacetabular osteotomy provides a joint preserving option for the treatment of acetabular dysplasia but is generally considered technically demanding, which has limited its widespread application. This study evaluates a new computer enhanced technique for a trans-trochanteric periacetabular osteotomy. This multi-use computer interface designed and used at Kingston General Hospital and Queen’s University has been previously and successfully used in many different types of surgical procedures. Interim results show few complications and accurate guidance.

To develop a new periacetabular osteotomy technique that can be performed safely and reliably using computer-enhanced technology.

This technique has enabled us to perform periacetabular osteotomies with few complications and increased accuracy of component alignment and sizing.

Using this computer-enhanced technique, periacetabular osteotomy may become a more common procedure in the practice of hip reconstruction.

Candidates include adults with symptomatic acetabular dysplasia. Pre-operative radiographs and CT scans are obtained. The scan is digitized to create a 3D model used for osteotomy planning. A trans-trochanteric approach is used to the acetabulum. An intra-operative plan is followed for osteotomy cuts. Fixation is achieved with two pelvic reconstruction plates. Peri-operative data on correction, complications and clinical data (WOMAC and SF36), and xrays and one year 3D CT scans are collected prospectively. This procedure has been performed on eighteen patients with an average centre edge angle correction of ninteen degrees. The computer guidance system has given accurate information in all but one case, which was successfully completed with limited guidance. No cases of intra-articular or posterior column fractures, nerve injury or AVN have occurred. Two cases of trochanteric pull-off were revised without complication. One case of delayed union of the pubic rami osteotomy was bone grafted and subsequently healed. One case of radiographic, but not clinical heterotropic ossification occurred in a patient with contraindications to prophylaxis. This new technique provides a reliable and reproducible option for acetabular correction with low complication rates.