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Bernese periacetabular osteotomy

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Bernese periacetabular osteotomy

  1. 1. Bernese Periacetabular Osteotomy for Hip Dysplasia - Salomi R. Vora
  2. 2. Progression of Hip Dysplasia1 Congenital/ acquired mal- alignment Reduced femoral coverage Increased contact stress at hip Degenerative joint disease Total hip Arthroplasty
  3. 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. 4. Advantages of Osteotomy: Reorients acetabulum Increases load bearing area of hip. Reduces contact hip stress Prevents or delays progression of OA
  5. 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. 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. 7. Functional Measures for Follow up1 WOMAC score Tonnis Classification for OA
  8. 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. 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. 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. 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. 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.

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