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
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)
10. 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
11. 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
12. 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.
14. 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.
Editor's Notes
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)
