Introduction and aims: Numerous questionnaires are available to assess outcome of hip arthroplasty, but as yet there is no consensus as to which are the most appropriate to use following acetabular osteotomy. We have prospectively evaluated a quality of life measure validated for patients from the United Kingdom and self-administered disease and hip specific questionnaires in patients undergoing Bernese periacetabular osteotomy and compared these to outcome as measured by the Harris hip and Merle d’Aubigne and Postel hip scores. Method: Since 1997, 24 Bernese periacetabular osteotomies have been performed at our institution. Only patients with a primary diagnosis of development dysplasia of the acetabulum, no evidence of degenerative disease and a minimum of 24 months of follow-up were included in this study. Any non life-threatening co-morbid conditions were documented and recorded. Harris hip (HHS), Merle d’Aubigne and Postel (MDP), Nottingham Health Profile (NHP) and Oxford Hip scores (OHS) were calculated pre-operatively and post-operatively at 6 weeks, 12 weeks, 6 months, one year and then yearly. Results: Patients have been followed up for an average of 3.2 years (range: 1–5.5 years). The male: female ratio was 1: 8.5. The average age at time of operation was 32.3 years (range 18 – 48). No patient required further surgery or conversion to total hip arthroplasty. Mean postoperative HHS was 89.9. MDP 16.4 and OHS 16.3. All dimensions of the NHP demonstrated improvement of greater than 50 %. The MDP and OHS were most sensitive to time of assessment in the post-operative period. There was no significant difference in the order of magnitude of improvement between any of the scores. Conclusion: This study has demonstrated that the Bernese periacetabular osteotomy, in a carefully selected group of patients, has a reproducibly good outcome as measured by a variety of scoring methods dependent upon both clinician and patient derived assessment

Since 1984, more than 1000 Bernese periacetabular osteotomies (PAO) have been performed for the treatment of developmental dysplasia of the hip (DDH) in adolescents and adults at the institution where this technique was developed. We present a concise 20-year follow-up of the first 75 PAOs whose initial and 10-year results had been published previously. A retrospective study of the first 75 consecutive hips (63 patients) treated with PAO for DDH between April 1984 and December 1987 was performed. The mean patient age at surgery was 29.3 years ± 11.4 (13 – 56) and in 31% of all hips a previous surgical attempt to achieve sufficient coverage had been performed. Preoperatively, 58% of all hips presented with osteoarthritis and 49% with dysplasia Class 4 or higher according to Severin. Four patients (5 hips) were lost-to-follow-up and 1 patient (2 hips) died unrelated to surgery. The remaining 58 patients (68 hips) were followed for a mean of 20.4 years ± 1.1 (18.8 – 22.9) and 41 hips (60%) were preserved at last follow-up. Regarding the surviving hips with preoperatively no or slight osteoarthritis (52 hips), the survivor ship rate was 75%. Twenty-seven hips were converted to a THA (26 hips) or hip arthrodesis (1 hip) which were defined as endpoints. The cumulative Kaplan-Meier survivorship at 20 years was 61%. The Cox regression analysis was performed to detect predictive factors for poor outcome and to calculate the corresponding hazard ratios. Six predictive factors for poor outcome were found: age over 30, a preoperative Merle d’Aubigné score less than 15, a positive preoperative anterior impingement test and limp, preoperative OA grade of more than 1, and a postoperative extrusion index of more than 20%. Despite the fact that this series represented the learning curve of a technically demanding intervention of a very inhomogeneous patient group with various previous surgical attempts to achieve sufficient coverage and several concomitant intertrochanteric osteotomies, the 20-year results on the first 75 hips are promising. Increased survivorship rates are expected for more recent series after identification of relative contraindications based on or analysis. PAO is an effective and successful surgical technique for correction of DDH

The Bernese periacetabular osteotomy (PAO) is a well-established procedure in the management of symptomatic hip dysplasia. The associated Smith-Petersen exposure offers excellent visualization of the acetabulum and control of acetabular osteotomy and mobilization. The traditional exposure of the true pelvis involves osteotomy of the iliac wing in order to mobilize the sartorial and inguinal ligament insertion. However, full osteotomy of the iliac spine may necessitate screw fixation if a relatively large segment of bone is included. A known complication with screw fixation of the iliac wing osteotomy involves failure of fixation and screw back out. Moreover, the screw may be irritative to the patient even in the setting of adequate fixation. A larger osteotomy may also injure the lateral femoral cutaneous nerve as it travels near the anterior superior spine. To minimize the risk of these potential complications, a wafer osteotomy may be used to develop a sleeve of tissue involving the sartorial insertion. Markings may be made so that the curvilinear incision is centered about the anterior-superior iliac spine (ASIS). The sartorial sleeve also mobilizes the entirety of the lateral femoral cutaneous nerve medially as it runs and branches to varying degrees in a fatty tissue layer in the tensor-sartorius interval directly beneath the subcutaneous layer, thereby affording protection throughout the procedure. When the ASIS is first osteotomized as a several millimeter-thick mobile fragment and reflected, the sartorius attachment to the mobile fragment of the wafer osteotomy may be preserved. Furthermore, the wafer osteotomy may be re-fixed to the stable pelvis during closure with simple heavy suture fixation alone, avoiding screw insertion or associated removal. Because only a wafer or bone is taken during the spine osteotomy, more bone is available at the ASIS for fixation of the mobile fragment after repositioning. In this technical note, we describe the wafer osteotomy technique in further detail. For any figures or tables, please contact authors directly

Introduction: Minimal invasive surgery (MIS) seems to be part of future orthopaedic solutions. Currently, most approaches for the Bernese periacetabular osteotomy (PAO) are characterized by relatively extensive incisions, dissection and detachment of muscles. We have developed a new MIS approach for the Bernese PAO. The purposes were to reduce patient morbidity and to improve the cosmetic result following surgery without negatively influencing the achieved reorientation of the acetabular articular surface. In this study we present the surgical technique, results and compare them to the ilioinguinal (II) approach. Methods: The new MIS technique is a trans-sartorial approach using a three inch skin incision. Previously the II approach was used. From 1999–2006 a total of 215 patients with acetabular dysplasia were operated by the same surgeon in two successive time periods with the II (97) and the trans-sartorial (118) approaches. No supplemental surgery was performed. The two approaches are retrospectively compared regarding perioperative measures, transfusion requirements, complications and the achieved reorientation of the acetabular articular surface. Data are compared by Kruskal-Wallis Test and are presented as median and interquartile range. Results: The trans-sartorial approach significantly reduced days of admission (8 days (7–9) vs. 10 days (8–13), p< 0.0001), duration of surgery (70 min (60–75) vs. 100 min (82.5–120), p< 0.0001), perioperative blood loss (200ml (150–350) vs. 450ml (325–700), p< 0.0001) and the percentage of patients receiving blood transfusion (18.6 % vs. 3.4%). Of severe neurovascular, infectious and technical complications none occurred in the trans-sartorial group and 3 cases of arterial thrombosis were seen in the II group. The achieved reorientation measured by the CE-angle postoperatively had median values of 31° (25–36) in the II group and 33° (29–36) in the trans-sartorial group, p=0.016. The postoperative AI-angles were 10° (2–14) and 3° (0–7) in the II and trans-sartorial groups respectively, p< 0.0001. Discussion: Our shift to the trans-sartorial approach was rewarding as the duration of surgery, perioperative blood loss and transfusion requirements were reduced. The new MIS technique is safe and improves the cosmetic result without negative influence on the achieved reorientation of the acetabular articular surface

The periacetabular osteotomy(PAO) is an effective common hip-preserving procedure to treat symptomatic acetabular dysplasia of the hip (DDH). The literature regarding truly long-term patient outcomes after PAO remains limited. We sought to evaluate our patient cohort treated by PAO 25 to 33 years ago to identify factors positively and negatively associated with durable therapeutic success.

219 dysplastic hips (183 patients) underwent PAO between August 1991 and December 1999 by a single surgeon. 164 hips in 134 patients were retrospectively evaluated at minimum of 25 years and maximum of 33 years post-operatively. Hips were evaluated using the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) postoperatively. Osteotomy failure was defined as WOMAC pain score of >/=10 or the need for total hip arthroplasty (THA). 7 patients (7 hips) had died - none of whom had THR. 142/176 remaining patients were located. All patients returned questionnaires; some were seen in person with images.

Of patients analyzed to date, 109 hips (63%) were asymptomatic/mildly symptomatic with a preserved hip. 58 hips (33%) had undergone THA. 7 preserved hips (5%) were symptomatic (WOMAC>10). Patients with THA were slightly older than asymptomatic patients (54 ± 8 years vs. 50 ± 11 years; p=0.08), as they had been at time of PAO. Most patients were female (83%), with 89% of hip replacement patients being female. 4/58 replaced hips had been revised - 3 for instability and 1 for acetabular loosening. Data collection is ongoing as more patients are located and reviewed.

Long-term follow-up of patients is challenging. Review after minimum of 25 years of the Boston cohort treated with PAO after minimum of 25 years dysplasia reveals that most at long-term follow-up report high levels of function, whether or not they had required arthroplasty, although 33% had required interim treatment with THA.

The periacetabular osteotomy (PAO) is a well-described procedure for symptomatic acetabular dysplasia. For severe acetabular deformities, the efficacy of acetabular reorientation remains controversial and the literature on mid to long-term outcomes is limited. The purpose of this study was to analyze average 10-year clinical and radiographic results of the PAO for severe acetabular dysplasia.

We retrospectively analyzed a consecutive series of patients undergoing PAO for severe acetabular dysplasia as defined by LCEA < 5˚. Patient demographics, radiographic measurements, modified Harris Hip score (MHHS), UCLA activity, SF-12, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed.

Sixty-eight patients (82 hips; 54 females) with an average age 20.7 and BMI of 24.4 kg/m2 were included. Mean follow-up was follow up was 10.3 years. . The LCEA and ACEA improved a mean of 32.8˚ (8.4˚ to 24.4˚, p<0.0001) and 31.6˚ (−4.9˚ to 26.7˚, p< 0.0001), respectively. MHHS improved an average of 17.5 points (64.6 to 82.3, p<0.0001), WOMAC Pain subscore improved an average of 21.1 points (65.7 to 85.0, p = 0.004), and SF-12 physical improved 11.8 points (from 40.3 to 50.6, p = 0.006). Activity improved as indicated by a 1.5-point increase in the UCLA Activity score (6.4 to 7.9, p=0.005). Six hips (9.1%) converted to THA at average 6.8 years post-PAO. Kaplan-Meier survival analysis with THA as the endpoint was 92% at 15 years (95% confidence interval [CI] (81%–96%). Multivariable linear regression analysis revealed concurrent osteochondroplasty was associated with a decreased risk of PAO failure.

PAO is an effective treatment for severe acetabular dysplasia. At average 10.3 years, clinical and radiographic outcomes demonstrate pain relief, improved hip function, and major deformity correction. We observed minimal clinical deterioration over time.

Introduction

Since its first description in 1988, periacetabular osteotomy has become the gold-standard worldwide in surgical treatment of developmental dysplasia of the hip. Several long-term studies have proven the efficacy of this procedure. In this study, we evaluated the mean 30-years results of this procedure of the first 63 patients (75 hips) operated at the institution where this procedure had been developed.

We utilized a dry-bone model of the pelvis and proximal femur, set upon transparent Lucite plates with four mounting screws and adjustable struts, allowing measurable and reproducible pelvic tilt and rotation. Our protocol for osteotome placement at each of the osteotomy sites strictly followed the technique described by Ganz. A 30°, 15 mm bifid osteotome was used for imaging at the initial ischial osteotomy at the infracotyloid groove. A 30°, 2 cm straightedge osteotome was placed 4 cm below the pelvic brim to image the retroacetabular osteotomy on the quadrilateral plate. Various osteotome placements were imaged with the C-arm image intensifier to better define the risks of inferior and posterosuperior intraarticular osteotomies at each of these sites, respectively. A 600 osteotome oriented at 500 to the quadrilateral plate was also utilized.

In addition, violation of the inferior quadrant of the joint as well as posterolateral slipping of the osteotome blade along the posterior column, were appreciated on all images of pelvic flexion and rotation. The false-profile view always confirmed the perpendicular orientation of the osteotome blade. The false-profile view allowed for accurate evaluation of the positioning of the 30°, 2-cm straightedge osteotome along the retro-acetabular osteotomy site. In the views obtained, the blade could be seen aligned parallel to the posterior surface of the acetabulum, while respecting the posterosuperior joint space with optimal step-off from the posterior column. False-profile and posterior judet views provided optimal visualization of the 60° osteotome on the quadrilateral plate. In addition, pelvic flexion and rotation did not impact the ability to visualize the inferior margin of the acetabulum in evaluating the potential for creating an inferior intraarticular osteotomy. The results of our study indicate that awareness of the appearance of ideal osteotome placements at each osteotomy site on AP and false profile C-arm image intensification will decrease the incidence of iatrogenic osseous and therefore neurovascular complications reported in the literature and reduce post-operative patient morbidity.

The role of femoral and acetabular version in correction of dysplasia of the hip has been undereported. Between June 1995 and September 2000, a Bernese periacetabu-lar osteotomy (BPO) was performed in 25 patients (26 hips) by the senior author with an average follow-up of 3.7 years (range 2-5 years). The mean age of the patients (24 female, 1 male) at the time of surgery was 29.4 years (range, 11.5 to 45 years). Only patients with a primary diagnosis of acetabular dysplasia were included in this series.

The average Harris hip score increased from 55.1 (range 34–75) preoperatively to 92.9 (range 72–100) at the latest follow up (p< 0.0001). The mean pre-operative Merle d’Aubign score increased from 13.5 (range 10–15) to 17 (range 15–18) at the latest follow up. The mean lateral centre edge angle of Wiberg increased from 13.10 (range 00–200) pre-operatively to 52.60 (range 200-740) at latest follow-up (p< 0.0001). The anterior centre edge angle averaged 10.90 (range 4-170) pre-operatively and improved to 490 (range 210–760) at latest follow-up (p< 0.0001). The Mckibbin instability index is the sum of femoral and acetabular version (normal range 200–500). There were 6 hips with low instability index and 11 hips with high instability index pre-operatively. At the latest follow-up there were only 2 hips with low instability index and there were no patients with a high instability index. Our clinical results showed fi fteen patients with excellent results, eight good results and one fair and one poor results. Thus, overall good to excellent results were obtained in 92% of our patients. It is therefore possible that we had higher success rate in our series than that reported in other series because of the correction of version of the hip in addition to the coronal and sagittal defi ciency of the hip.

We present the early results of the Bernese osteotomy via an ilioinguinal approach performed at an U.K. district general hospital with no links to the Bernese group.

Between 1997 and 2002, 19 such osteotomies have been performed at our institution. Average follow-up is 3.2 years (range: 1–5.5 years). The male: female ratio was 1: 8.5. Average age at time of operation was 32.3 years (range 18 – 48). 14 were classified as having Severin grade 2 dysplasia and 5 as having Severin grade 3 dysplasia. The average preoperative Merle d’Aubigne and Postel score was 12.7 points (range 6 – 15). 21.1% of patients were rated as good, as 57.8% fair and 21.1% poor.

At most recent follow-up of preserved hip joints total mean score had increased to 16.3 (range 13 – 18). 26.3% of hips were graded as excellent, 58.9% as good and 14.8% as fair. The average postoperative values for the lateral centre-edge angle and acetabular index were 42.3° and 10.0° respectively which represents an average of 31.4° and 24.7° of improved lateral and loading zone coverage after osteotomy. The preoperative severity of osteoarthritis according to the criteria of Tonnis was grade 1 in 15.8% and grade 2 in 26.3%. Only one joint deteriorated sufficiently for it to be converted to a total hip arthroplasty. There was an overall complication rate of 59.9% comprised of 47.4% trivial, 10.4% moderate and 0.05% major complications. Our early results demonstrate the steep learning curve of this technically demanding operation and are encouraging.

Management of symptomatic residual acetabular dysplasia in adolescence and early adulthood remains a major therapeutic challenge. At our unit the two senior authors review all patients preoperatively and simultaneously perform each procedure. In the four years from 1998 forty-three Bernese osteotomies were performed in 40 patients with residual acetabular dysplasia. The mean average age at surgery was 21 years (range 12 – 43 years) and there were 34 female patients. The indication for surgery was symptomatic hip dysplasia (all idiopathic but for one male with a history of slipped capital femoral epiphysis) presenting with pain and restricted ambulation. 4 patients had previous surgery on the affected hip (2 Salter’s osteotomy, one Shelf procedure and one proximal femoral osteotomy). 27.5% of patients had symptomatic bilateral disease. 42% of patients had Severin class IV or V dysplasia at presentation. 100% of patients had preservation of the hip joint at last follow-up evaluation (mean 2.4 years), with excellent results in 82%, an average post-operative Harris hip score of 96, and an average d’Aubigne hip score of 16.1. The mean post-operative improvements in radiographic measures were as follows: Anterior centre edge angle +19.4°, Lateral centre angle +25.8°, Acetabular Index – 10.7°. Head to Ischial distance – 7.3mm. Surgical operative time decreased from 128 minutes to 43 minutes from the first to the most recent case. Average blood loss has reduced from 1850mls to 420mls over the four years experience. Predonation of 2 units of blood requested from all patients with baseline hemoglobin of > 12g/dl. When combined with intraoperative cell salvage the need for transfusion of homologous blood has been eliminated. All complications occurred in the first 9 patients: (one major – iliac vein injury requiring no further treatment; four moderate – lateral cutaneous nerve injuries; four minor – asymptomatic heterotopic ossification). Our experience confirms that the Ganz peri-acetabular osteotomy is an efficacious procedure for the treatment of the residually dysplastic hip, providing excellent clinical results, where early intervention is the key to improved outcome. It is a technically demanding procedure with a significant early learning curve and we believe that a two-surgeon approach is invaluable to the management of these difficult cases.

Aims

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

Study Design. Retrospective clinical and radiographic review of patients after Bernese periacetabular osteotomy for symptomatic congenital hip dysplasia. Introduction. The Bernese periacetabular osteotomy for the treatment of symptomatic congenital hip dysplasia is known to be a complex operative procedure. Several authors reported significant percentages of peri- and postoperative complications. Objective.The aim of our study was to reveal whether the incidence as well as the grade of complications affect the postoperative outcome which was determined by the short form (SF) 36 and the Western Ontario McMasters osteoarthritis (WOMAC) questionnaires. Methods. A consecutive series of 50 patients with 60 hips operated between 1988 and 2000 were investigated retrospectively with a mean follow up period of 32 months. Results. With an incidence of 30% a lesion of the lateral cutaneus nerve occurred. In 10% a peroneal nerve palsy was diagnosed immediate postoperatively, with 4% persistent neurological deficit presented at one year follow up. Several other minor and major complications occurred with an overall complication rate of 68%. According to the severity of complications two groups of patients were identified. Statistical analysis did not reveal any difference between the results of the SF-36 (p=0.2) and WOMAC (p=0.09) questionnaires. Radiological analysis revealed a deterioration of osteoarthritis in 32% of our patients. These patients predominantly judged their postoperative results poor to fair (r=0.71). 76% rated the operation as successful and 64% would have surgery again. The subjective estimation of patients health status postoperatively was significantly reduced compared to an age matched healthy reference group (p=0.0001). Conclusion. Despite the high incidence of complications 76% of the patients rated the operation as successful. 32% of the patients faced a deterioration of osteoarthritis. The postoperative results after Bernese periacetabular osteotomy are rather more influenced by the progression of osteoarthritis than by the occurrence of perioperative complications

Adult hip dysplasia AHD is a complex 3D pathology of lateral coverage, version and/or volume and is often associated with increased femoral anteversion. The Mckibbin index MI is the combination of acetabular version AV and femoral version FV and is used as a measure of anterior hip Stability/ Impingement(1). The Bernese Periacetabular osteotomy PAO is a powerful tool in treating AHD, but it does not address FV. De-rotational femoral osteotomies FO increases risk of complications, operative time and might condemn the patient to Secondary osteotomies to balance the gait. We aim to investigate the effect of MI and FV on PROMs in patients undergoing PAO only. 593 PAOs identified on the Local Hip preservation registry between 01/2013 and 7/2023. PAOs for retroversion, residual Perthes and those combined with FO were excluded. Patients with no available PROMS at 2 years were excluded. Independent variables were collected from E-notes and imaging including MI and FV. A multiple linear regression analysis was performed against preoperative iHot12, and iHot12 change at 2years. The mean FV was 18.86± 12.4 SD. Mean MI was 36.07, SD 15.36. Mean preop iHot12 score was 29.83 ± 17.38 SD. Mean change in iHot12 at 2 years was+36.47 ± 28.44 SD. Females and a higher BMI were statistically correlated to a lower preoperative iHot12. A lower preop iHot12 score and a higher preop AI were correlated to a bigger change in iHot12 at 2years with statistical significance. MI and FV were not found to have a statistically significant correlation with Outcome measures,. An increased Mckibbin index and femoral anteversion were not correlated with worse outcomes at two years. PAO alone in the presence of increased femoral anteversion avoids risks associated with FO which can be performed later if required

The Bernese periacetabular osteotomy (PAO) is not indicated for growing hips as it crosses the triradiate cartilage in its posterior branch, and experimental work has shown this can induce substantial deformations, similar to posttraumatic dysplasia, which is observed after pelvis crash injuries in childhood. Upon examination, all injuries in the 19 cases of posttraumatic dysplasia described in literature plus 16 hips of our personal collection took place before the age of 6, which is striking as pelvic injuries in children increase with age. Based on this observation, we started to extend the PAO indication to severe dysplasias in children with open growth plate, initially aged 9 years and older. Following the positive results, it was extended further, our youngest patient being 5 years old. We retrospectively examined radiographic outcomes of 23 hips (20 patients), aged 10.6±1.8 years [range 5.0 – 13.2], operated by us in four centers. Pre- and 3-months postoperative, and the latest FUP radiograph at growth plate closure were measured. We evaluated the acetabular index (AI), lateral center-edge (LCE), ACM-value and compared them with reference values adjusted for age. The age at triradiate cartilage closure was compared with the non-operated side. The follow-up time was 5.4±3.7 years [0.8 - 12.7]. In 5 hips, growth plate closure was delayed by a few months. All angles significantly normalized after PAO (LCE: 14±8° → 38±11°, AI: 20±8° → 7±4°, ACM: 53±5° → 48±4°), with >80% of them severe pathological pre-PAO, none afterwards. Acetabular molding was normal. Only few complications occurred; one had signs of coxarthosis, one sciatic nerve pain, one interfering osteosynthesis material that was removed, one had an additional valgus osteotomy, and all resolved. Based on 20 cases with follow-up until complete triradiate cartilage closure, we believe to have sufficient information to extend the PAO indication to growing hips of 9 years and older

The purpose of this study was to determine the complications after Bernese periacetabular osteomy (PAO) performed by one experienced surgeon using a minimally invasive modified Smith-Petersen approach. Between May 2012 and December 2015, 224 periacetabular osteotomies (PAO) in 201 patients were performed. The perioperative complications were retrospectively reviewed after reviewing clinical notes and radiographs. The mean age was 28.8 years with 179 females and 22 males. The most common diagnosis was acetabular dysplasia with some cases of retroversion. The average lateral centre edge (LCE) angle was 16.5°(−18–45) and mean acetabular index (AI) 16.79° (−3–50). Postoperatively the mean LCE angle was 33.1°(20–51.3) and mean AI 3.0°. (−13.5–16.6). There were no deep infections, no major nerve or vascular injuries and only one allogenic blood transfusion. Nine superficial wound infections required oral antibiotics and two wounds needed a surgical debridement. There was one pulmonary embolus and one deep vein thrombosis. Nine (4%) cases underwent a subsequent hip arthroscopy and three (1.3%) PAO's were converted to a total hip arthroplasty after a mean follow-up of 22 months (3–50). Lateral femoral cutaneous nerve dysaesthesia was noted in 64 (28.6%) PAO's. In 55 (24.5%) an iliopsoas injection of local anaesthetic and steroid for persistent iliopsoas irritation during the recovery phase was given. The minimally invasive modified Smith-Petersen approach is suitable to perform a Bernese periacetabular osteotomy with a low perioperative complication rate. Persistent pain related to iliopsoas is a not uncommon finding and perhaps under-reported in the literature

Introduction: We present the results of a prospective study of the blood transfusion requirements in patients undergoing a Bernese periacetabular osteotomy (PAO) with the use of an intra-operative cell-saver and without pre-donated blood. These data were compared with an earlier audit of patients who underwent this procedure without use of a cell saver. Material and Methods: A cohort of 50 patients (56 hips) underwent a PAO for hip dysplasia between December 2006 and November 2008 performed by the senior author. The average age was 29 years (17–51) and there were 38 females and 12 males. The average weight was 69.96 kg (46–110) and the mean duration of operation was 136 minutes (100–240). A cell saver (Fresenius-Hemocare, Germany) was used intra-operatively for this cohort. Pre-operative Hb, post-operative Hb taken the day after surgery and any units transfused were documented. A post-operative transfusion policy was adopted where a haemoglobin (Hb) concentration of < 7.5 g/dl was an indication for transfusion or where a patient was sufficiently symptomatic. Results: The mean pre-operative Hb was 13.60 g/dl (10.8–15.9) and the mean post-operative Hb was 9.91 g/dl (6.4–11.8). Overall 4 patients received post-operative allogenic blood transfusion; 3 patients receiving one unit and one patient receiving 2 units. No patients received intra-operative allogenic blood. Conclusion: Compared to our previous audit, the use of the cell saver resulted in an improvement in the mean post-operative Hb, (9.2 g/dl compared to 8.0 g/dl). The transfusion rate was also reduced (7.27% compared to 10.8%)

Purpose: The purpose of this study was to compare postoperative quality of life in patients with dysplasia who underwent Bernese periacetabular osteotomy to those who had total hip arthroplasty. Methods: Patients were included who had a diagnosis of dysplasia and were greater than 40 years old. Cases were patients who had a periacetabular osteotomy. Controls were patients who had undergone total hip arthroplasty. Patients were matched for gender, age, and comorbidity. There were 26 cases and 33 controls. Outcome tools were the Western Ontario McMaster Universities (WOMAC) osteoarthritis index, the SF-12, and the Arthroplasty Satisfaction Scale. T-tests were used to compare means between the groups. The chi-squared test was used to compare the percentage of patients who had very good, good, or poor outcomes between the groups. WOMAC scores were normalized on a 0–100 scale with 0 being worst and 100 being best. A WOMAC score > 75 was considered very good, 65–75 good, and below 65 poor. Results: The mean follow-up was just over 4 years in both groups. There was a clinically and statistically significant difference in WOMAC pain and function scores favouring the total hip patients. Mean WOMAC pain scores were 89 vs 71 (p< 0.0050). Mean WOMAC function scores were 91 vs74 (p< 0.005). Ninety-seven percent of total hip patients had a good or very good result vesus 73% of the osteotomy patients (p< 0.05). Conclusions: Total hip arthroplasty gives a more consistent and better return of quality of life in patients over 40 when measured at a mean of 4 years after operation. Future research should be directed toward preoperative and intraoperative factors that could improve the outcome of patients having an osteotomy in this age group

The Bernese Periacetabular Osteotomy (PAO) has become the established method for treating developmental dysplasia of the hip. In the 1990s, the surgical technique was modified to avoid postoperative cam impingement due to uncorrected head neck offset or pincer impingement due to acetabular retroversion after reorientation. The goal of the study was to compare the survivorship of two series of PAOs with and without the modifications of the surgical technique and to calculate predictive factors for a poor outcome. A retrospective, comparative study of two consecutive series of PAOs with a minimum follow-up of 10 years was carried out. Series A included 75 PAOs performed between 1984 and 1987 and represent the first cases of PAO. Series B included 90 hips that underwent PAO between 1997 and 2000. In this series, emphasis was put on an optimal acetabular version next to the correction of the lateral coverage. Additionally, a concomitant arthrotomy was performed in every hip to check impingement-free range of motion after reorientation and in 50 hips (56%) an additional offset correction was performed. Survivorship analyses according to Kaplan and Meier were carried out and the endpoint was defined as conversion to a total hip arthroplasty, progression of osteoarthritis, or a Merle d'Aubign score 14. Predictive factors for poor outcome were calculated using the Cox-regression analysis. The cumulative 10-year survivorship of Series A was significantly decreased (77%; 95%-confidence interval [CI] 72–82%) compared to Series B (86%; 95%-CI 82–89%, p=0.005). Hips with an aspherical head showed a significantly increased survivorship if a concomitant offset correction was performed intraoperatively (90% [95%-CI 86–94%] versus 77% [95%-CI 71–82%], p=0.003). Preoperative factors predicting poor outcome included a high age at surgery, a Merle d'Aubign score 14, a positive impingement test, a positive Trendelenburg sign, limp, an increased grade of osteoarthritis according to Tönnis, and (sub-) luxation of the femoral head (Severin > 3). In addition, predictive factors related to the three dimensional orientation of the acetabular fragment were identified. These included total, anterior, and posterior acetabular over-coverage or under-coverage, acetabular retroversion or excessive anteversion, a lateral center edge angle < 22 °, an acetabular index > 14 °, and no offset correction in aspherical femoral heads. A good long term result after PAO mainly depends on optimal three-dimensional orientation of the acetabulum and impingement-free range of motion with correction of an aspherical head neck junction if necessary

Dysfunction of acetabular dysplasia is a complex problem which includes excessive stresses on the cartilage, dynamic instability and muscular fatigue eventually leading to degenerative osteoarthrosis if left uncorrected. The most physiologic solution for a young adult with this problem is to redirect the acetabulum into a normal position. Rotational acetabular osteotomy developed in Japan aims to transfer the position of the acetabulum en bloc by circumacetabular osteotomy using the curved osteotome. Because of same curvatures of osteotomy surfaces, this osteotomy produces the greater contact among bony surfaces, stable fixation and early solid union. However, this osteotomy requires abductors splitting, leaves acetabular teardrop in its original position, and has the risk of postoperative avascular necrosis of the transferred acetabulum. Bernese periacetabular osteotomy developed by Ganz also provides good coverage of the femoral head by redirecting the acetabulum. This osteotomy preserves the vascular supply of the transferred acetabulum and allows medialization of the hip joint. On the other hand, it poses the risk of considerable morbidities due to extensive exposure, and major and/or moderate complications, such as bleeding complications, reflex sympathetic dystrophy, motor nerve palsy and heterotopic ossification are reported. In order to reduce these disadvantages, we developed a curved periacetabular osteotomy (CPO), for the treatment of hip dysplasias and have performed CPO on more than 400 hips since 1995. Both an imaging of the margin of the hip presumed to be on the quadrilateral surface and a sophisticated operative technique are needed for CPO. However, the extent of soft tissue dissection is limited with abductors left intact, and the osteotomy surfaces retain their original curvature. There have been no major or moderate complications. These advantages seem to reduce postoperative complications and promote early postoperative rehabilitation. Recently, we compared surgical invasion and complications in patients aged over 40 years who underwent CPO (n=30) or total hip arthroplasty (THA; n=30) using postoperative levels of interleukin (IL)-6 and C-reactive protein (CRP). The mean IL-6 levels were 55.4 pg/ml and 89.5 in the CPO and THA groups, respectively (p< 0.001). The mean CRP levels were 4.5 mg/dl and 5.8 in the CPO and THA groups, respectively (p< 0.01). No major or moderate complications were encountered in either group. CPO appears to be a less invasive and safer surgical procedure for middle-aged patients than THA