A LESS-INVASIVE APPROACH TO PERIACETABULAR OSTEOTOMY IN DDH

Abstract

For the prevention of premature osteoarthritis of the hip, the periacetabular osteotomy (PAO) of Ganz has become a common procedure. Though being a powerful method for obtaining large correction angles its drawback is the need for a broad exposure, resulting in more or less disfiguring scars. We modified the surgical approach to PAO by using two small skin incisions and reduced the extent of deep exposure by leaving the rectus femoris tendon in place and avoiding larger peri-articular deep soft tissue release.

The aim of this study is, to compare the early clinical and radiographic results of this less invasive approach with the conventional Smith-Peterson approach.

Patients and Methods: Between 01/04 and 05/05 22 consecutive PAO were performed through a conventional Smith-Peterson approach (group A). After introducing the less invasive technique 22 PAO were performed between 09/04 and 11/05 (group B). All patients were operated by the same experienced surgeon. Patients age ranged from 14 years to 46 years (mean age 26 years). Clinical (i.e. Harris-Hip-Score, Vancouver Scar Scale) and radiographic examinations (i.e. CE-angle) were performed preoperatively and postoperatively at an average follow-up of 16 months (range 6–29 months).

Results: Mean CE-angle correction in group A was 17° and in group B 23°. Functional improvement, as rated by the preoperative to postoperative Harris-Hip-Score-difference, was 15 points in group A and 22 points in group B. After the less-invasive approach, scars were considerable smaller and better-rated by the Vancouver Scar Scale (3 versus 4 after conventional surgery). The number of transient lateral cutaneous femoral nerve lesions was the same in both groups. The average time of surgery was 135 min. in group A and 153 min. in group B.

Conclusion: A smaller skin incision and limited soft tissue exposure improves cosmetic results after PAO without influencing the extent of acetabular correction negatively. The early and mid-term postoperative functional results, however, could not be significantly improved by the less invasive approach.