COMPARISON OF TWO SURGICAL APPROACHES ON ACETABULAR REORIENTATION, PERIOPERATIVE VARIABLES AND CLINICAL OUTCOME IN RELATION TO PERIACETABULAR OSTEOTOMY (PAO)

Abstract

Background: Dysplasia of the hip is associated with hip pain and development of secondary osteoarthrosis. An early intervention by a PAO is both a pain relieving treatment and it prolongs or eliminates the development of osteoarthrosis. Different surgical approaches have been used to perform the PAO. We have compared a modified iliofemoral (MI) approach and the ilioinguinal (II) approach on acetabular reorientation, perioperative variables and clinical outcome.

Patients and Method: We included 90 PAO’s performed on 75 patients with symptomatic hip dysplasia operated between February 2003 and July 2006 at Odense University Hospital. The variables in this study are center edge (CE) and acetabular roof angle (AA), Harris Hip score (HHS), WOMAC, pain (VAS), satisfaction with surgery, level of activity, quality of life (EQ5D), peri-operative blood loss, operating time and neurovascular complications.

Results: The MI approach was used in 71 PAO’s and the II in 19 PAO’s. Overall, patients had a significantly better result after the PAO compared to before with regard to HHS, pain and WOMAC, EQ5D. Reorientation measured on pre- and post-operative CE- and AA-angles showed no significant difference between the two groups. Operating time proved the MI approach significantly faster then the II-approach (p< 0.05). The intraoperative blood loss and pre-operative Hb-conc. was equal in the two groups. However, there was a significant lower postoperative Hb-conc. using the II-approach. The II group had one case of arterial thrombosis and none in the MI group. In both groups, half the patients had dysaesthesia related to the lateral cutaneous femoral nerve.

There were no significant differences between the two approaches with regard to pre- and post-operative HHS, WOMAC, patient satisfaction, level of activity and EQ5D

Conclusion: Although the II approach offers better access to the pubic bone, we did not find any difference in reorientation of the acetabular fragment. Both groups improved significantly in clinical outcome and quality of life. We find the MI approach safer than the II, as no arterial thrombosis was seen in that group.