Surgical Technique: Reverse Periacetabular Osteotomy

Albers, Christoph E.; Steppacher, Simon D.; Tannast, Moritz; Siebenrock, Klaus A. (2015). Surgical Technique: Reverse Periacetabular Osteotomy. In: Nho, S.J.; Leunig, M.; Larson, C. M.; Bedi, A.; Kelly, B. T. (eds.) Hip Arthroscopy and Hip Joint Preservation Surgery (pp. 637-651). New York: Springer 10.1007/978-1-4614-6965-0_116

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Acetabular retroversion is the result of an externally rotated hemipelvis rather than a focal overgrowth of the anterior wall and/or hypoplasia of the posterior wall. Acetabular retroversion is a cause of pincer impingement which, if left untreated, can lead to hip pain and osteoarthritis. The causal surgical treatment in hips with acetabular retroversion is acetabular reorientation with a reverse periacetabular osteotomy (PAO). Indication is based on a positive correlation among symptoms (typically groin pain), physical findings on examination (positive anterior impingement test and decreased flexion and internal rotation), and radiographic signs for acetabular retroversion. These include a positive crossover, posterior wall, and ischial spine sign. A reverse PAO is performed with four osteotomies and a controlled fracture. Unlike reorientation of the acetabular fragment in dysplastic hips, correction for acetabular retroversion is achieved by a combined extension and internal rotation of the acetabular fragment. Typically, a small supra-acetabular wedge resection is required to allow sufficient extension of the fragment. The quality of acetabular reorientation is evaluated by intraoperative AP pelvic radiographs. In addition, intraoperative testing of range of motion following acetabular reorientation is mandatory. An arthrotomy and offset correction of the femoral head-neck area is indicated in hips with decreased internal rotation following acetabular reorientation. In a 10-year follow-up study of reverse PAO, a favorable outcome with preservation of all native joints was found. Correct acetabular orientation and, if necessary, a concomitant offset correction were the keys of successful outcome.

Item Type:

Book Section (Book Chapter)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Albers, Christoph; Steppacher, Simon Damian; Tannast, Moritz and Siebenrock, Klaus-Arno

Subjects:

600 Technology > 610 Medicine & health

ISBN:

978-1-4614-6965-0

Publisher:

Springer

Language:

English

Submitter:

Fabian Röthlisberger

Date Deposited:

04 Apr 2016 14:06

Last Modified:

06 Apr 2016 16:06

Publisher DOI:

10.1007/978-1-4614-6965-0_116

BORIS DOI:

10.7892/boris.77723

URI:

https://boris.unibe.ch/id/eprint/77723

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