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  • An osteotomy has been the surgical choice of intervention to improve functional outcomes in individuals with . Patients have been mobilized as soon as the third day post surgery with PWB using crutches.
  • It has many advantages: 1) it permits correction coverage medially, laterally, and anteriorly as needed while at the same time maintaining proper acetabular version; 2) it can be performed through a single incision, without damaging the abductors; 3) the pelvic ring and outlet are not disrupted, which per- mits early mobilization, there is no need for cast or brace immobilization, and it allows for future vaginal delivery without complication; and 4) one can perform a capsulotomy to assess the labrum and check for impingement without compromising the acetabular blood supply (Ganz et al. 1988, Trousdale et al. 1995). Intraoperative EMG is used to moniter the peroneal divisions sciatic and femoral nerve.Incisions performed through the inner aspect of the pelvis
  • 1. Probably due to increased degenerative changes in elderly patients.2.Many patients do not meet the criteria of No arthrosis (Murphy & Deshmukh, 2002.)
  • WOMAC measures for pain functional limitation and stiffness. The WOMAC is among the most widely used assessments in arthritis research.The Western Ontario and McMaster Universities Arthritis Index (WOMAC)

Transcript

  • 1. Bernese Periacetabular Osteotomy for Hip Dysplasia - Salomi R. Vora
  • 2. Progression of Hip Dysplasia1 Congenital/ acquired mal- alignment Reduced femoral coverage Increased contact stress at hip Degenerative joint disease Total hip Arthroplasty
  • 3. Introduction  The Bernese Periacetabular Osteotomy (BPO) was developed in 1984 and was published in 1988.2  This minimally invasive technique was developed to address the following needs; - Increased reorientation of acetabulum to increase hip contact area. - Increased stability of hemi- pelvis for immediate weight bearing in the post operative phase.1
  • 4. Advantages of Osteotomy: Reorients acetabulum Increases load bearing area of hip. Reduces contact hip stress Prevents or delays progression of OA
  • 5. Advantages of BPO:3 BPO • Appropriate correction coverage while maintaining acetabular version. • Single incision – no damage of abductors • No disruption of pelvic or outlet ring. • Allows for capsulotomy to assess the labrum/ any impingement.
  • 6. Criteria for performing BPO1,3:  Young age (at least < 50- 55 years old)  Presence of concentric / internal rotation hip motion.  Spherical joint surfaces.  No secondary arthrosis (Tonnis Grade 2/ less)
  • 7. Functional Measures for Follow up1 WOMAC score Tonnis Classification for OA
  • 8. Functional Outcome  Study 1: - Population = 24 patients - Follow up duration = mean of 3.5 years - Results = 18 out of 24 patients showed high functional level on follow up.4
  • 9.  Study 2: - Population = 26 patients with unilateral osteotomies. - Follow up duration = 7-15 years. - Results = 4 patients  THA, 8 patients considerable arthrosis and 14 patients no/ mild arthrosis on follow up. 1
  • 10. Post –Operative Therapy Recommendations1,3  Mobilization with partial weight bearing (20- 40 pounds)- 3 days.  AROM Exercises with > 90° - 4 weeks  Total weight bearing – 6-8 weeks.
  • 11. Resources  WOMAC score: http://www.rheumatology.org/Practice/C linical/Clinicianresearchers/Outcomes_Inst rumentation/Western_Ontario_and_McM aster_Universities_Osteoarthritis_Index_(W OMAC)/  Tonnis classification for OA: http://www.preventivehip.org/hip- scores/tonnis-classification THANK YOU
  • 12. References 1. Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V. The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7-15-year follow-up of 26 hips. Acta Orthopaedica. December 2005;76(6):833-840. 2. Ganz R, Klaue K, Vinh T, Mast J. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clinical Orthopaedics And Related Research. January 2004;(418):3-8. 3. Trousdale R, Cabanela M. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthopaedica Scandinavica. April 2003;74(2):119. 1. Badra M, Anand A, Straight J, Sala D, Ruchelsman D, Feldman D. Functional outcome in adult patients following Bernese periacetabular osteotomy. Orthopedics. January 2008;31(1):69.