PERIOPERATIVE BLOOD LOSS AND COMPLICATIONS IN RELATION TO PERIACETABULAR OSTEOTOMY IN ADULTS

Abstract

Introduction: Periacetabular osteotomy (PAO) is a major orthopaedic surgical procedure which may be associated with a significant blood loss and complications. We have compared the perioperative blood loss and complications using two different approaches – The modified iliofemoral (MI) and ilioinguinal (II) for PAO.

MATERIALS AND Methods: 92 PAO’s in 80 patients (54 females; 26 males), with dysplastic hip joints, operated at Odense University Hospital with the Bernese method, between 2003 and Feb. 2006, using the MI or the II were included. The MI include no release of the tensor fascia lata, sartorius or rectus femoris.

The procedures were reviewed with primary focus on perioperative blood loss, length of surgery and neurovascular complications. Patients who underwent combined surgery of acetabulum and femur were excluded.

Data are presented as mean with 95% confidence interval (CI) in brackets.

Results: The MI approach was used in 65 and the II in 27 PAO’s. Average time for surgery in the MI group was 88 min (95% CI: 83–94) and in the II group 106 min (95% CI: 97–114), (P=0.0007). The intraoperative blood loss in the MI group was 571 ml (95% CI: 489–654) compared with 518 ml (95% CI: 387–649) in the II group (P=0.49). However, postoperatively, the hemoglobin concentration was 7.1 (95% CI: 6.9–7.3) in the MI group compared with 6.6 (95% CI: 6.1–6.8) in the II group (P=0.002).

The MI group had 1 case of major arterial bleeding, however no blood transfusion. The II group had 2 cases of arterial thrombosis and one transient sciatic nerve palsy. One patient received blood transfusion.

CONCLUSION: In this study, the MI approach was proved to be significantly faster than the II, however no significant difference was found in intraoperative blood loss, but the hemoglobin fell significantly less in the MI compared with the II group. The II approach was associated with 3 major complication compared with one in the MI.