Aims. To determine whether there is any benefit using a minimally invasive trans-sartorial approach as described by Professor Søballe compared to the ilio-femoral for peri-acetabular osteotomy. Methods. 30 consecutive patients were operated on by a single surgeon. The first 15 underwent an ilio-femoral (I-F) approach whilst the following 15 had a trans-sartorial (T-S) approach. Fixation was achieved with 3 or 4 screws. All other aspects of surgery and rehabilitation were the same. Data was collected prospectively and included operation time, intra-operative blood loss and length of stay. Acetabular correction was measured using the sourcil and centre edge angle (CEA) on pre and post-operative radiographs. Results. Both groups had acceptable radiographic corrections with CEA improving from mean 14.5 to 38.7 degrees (T-S) and 14 to 39 degrees (I-F). The sourcil angle improved from mean 17.8 to 2 degrees (T-S) and 19.5 to −1.5 (I-F). Minimally invasive surgery reduced anaesthetic time by 62 minutes. Haemoglobin loss was reduced by 1 gram/L and there was no requirement for transfusion. Hospital stay reduced by 0.8 days. There were no major adverse complications although two partial femoral neurapraxias were noted early in the series. These fully resolved. Conclusion. We have found significant benefit from changing to minimally invasive PAO. Our patients have smaller wounds, a shorter operative time, reduced bleeding and a shorter length of stay. We found no adverse effects. The time savings have also corresponded to a cost saving for our institution. We recommend this technique although recognise that it has a learning curve and should be initiated by surgeons with previous PAO experience

Arthrosis of the hip joint can be a significant source of pain and dysfunction. While hip replacement surgery has emerged as the gold standard for the treatment of end stage coxarthrosis, there are several non-arthroplasty management options that can help patients with mild and moderate hip arthritis. Therefore, the purpose of this paper is to review early prophylactic interventions that may help defer or avoid hip arthroplasty. Nonoperative management for the symptomatic hip involves minimizing joint inflammation and maximizing joint mobility through intra-articular joint injections and exercise therapy. While weight loss, activity modifications, and low impact exercises is generally recommended for patients with arthritis, the effects of these modalities on joint strength and mobility are highly variable. Intra-articular steroid injections tended to offer reliable short-term pain relief (3–4 weeks) but provided unreliable long-term efficacy. Additionally, injections of hyaluronic acid do not appear to provide improved pain relief compared to other modalities. Finally, platelet rich plasma injections do not perform better than HA injections for patients with moderate hip joint arthrosis. Primary hip joint arthrosis is rare, and therefore treatment such as peri-acetabular osteotomies, surgical dislocations, and hip arthroscopy and related procedures are aimed to minimise symptoms but potentially aim to alter the natural history of hip diseases. The state of the articular cartilage at the time of surgery is critical to the success or failure of any joint preservation procedures. Lech et al. reported in a series of dysplastic patients undergoing periacetabular osteotomies that one third of hips survived 30 years without progression of arthritis or conversion to THA. Similarly, surgical dislocation of the hip, while effective for treatment of femoroacetabular impingement, carries a high re-operation rate at 7 years follow up. Finally, as the prevalence of hip arthroscopic procedures continues to rise, it is important to recognise that failure to address the underlying structural pathologies can lead to failure and rapid joint destruction. In summary, several treatment modalities are available for the management of hip pain and dysfunction in patients with a preserved joint space. While joint preservation procedures can help improve pain and function, they rarely alter the natural history of hip disease. The status of the articular cartilage at the time of surgery is the most important predictor of treatment success or failure

Purpose. To validate a small, easy to use and cost-effective augmented marker-based hybrid navigation system for peri-acetabular osteotomy [PAO] surgery. Methods. A cadaver study including 3 pelvises (6 hip joints) undergoing navigated PAO was performed. Inclination and anteversion of two navigation systems for PAO were compared during acetabular reorientation. The hybrid system consists of a tracking unit which is placed on the patient's pelvis and an augmented marker which is attached to the patient's acetabular fragment. The tracking unit sends a video stream of the augmented marker to the host computer. Simultaneously, the augmented marker sends orientation output from an integrated inertial measurement unit (IMU) to the host computer. The host computer then computes the pose of the augmented marker and uses it (if visible) to compute acetabular orientation. If the marker is not visible, the output from the IMU is used to update the orientation. The second system served as ground truth and is a previously developed and validated optical tracking-based navigation system. Results. Mean absolute difference for inclination and anteversion (N = 360) was 1.34 degrees and 1.21 degrees, respectively. The measurements from our system show a very strong correlation to the ground-truth optical tracking-based navigation system for both inclination and anteversion (0.9809 / 0.9711). Conclusion. In this work, we successfully demonstrated the feasibility of our system to measure inclination and anteversion during acetabular reorientation