Complications associated with the bernese periacetabular osteotomy for hip dyspl

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J Bone Joint Surg Am. 2010 Aug;92(8):1707-14.

Complications associated with the bernese periacetabular osteotomy for hip

dysplasia in adolescents.

Thawrani D, Sucato DJ, Podeszwa DA, Delarocha A.

Texas ish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX

75219.

Abstract

BACKGROUND: The Bernese (Ganz) periacetabular osteotomy is an effective surgical

procedure to reorient the acetabulum, allowing restoration of anatomic femoral

head coverage and medial translation of the hip in adults with hip dysplasia.

However, it is a challenging surgical procedure, and we know of no study that

has specifically analyzed the complications and associated factors seen with

this procedure in adolescent patients.

METHODS: A retrospective clinical and radiographic review of a consecutive

series of adolescent patients who underwent a Bernese periacetabular osteotomy

for hip dysplasia was conducted.

RESULTS: Eighty-three osteotomies were performed in seventy-six patients with an

average age (and standard deviation) of 15.6 +/- 2.4 years. Significant

improvement from the preoperative to the two-year follow-up evaluation was seen

radiographically with regard to the lateral center-edge angle (-0.14 degrees to

35.5 degrees ), the ventral center-edge angle (-5.13 degrees to 31.3 degrees ),

and the femoral head extrusion index (38.4% to 7.7%) (p < 0.0001 for all). There

were three major complications, including excessive arterial bleeding requiring

embolization in a patient with a prior acetabuloplasty, osteonecrosis of the

acetabular fragment in a patient with severe dysplasia and subluxation of the

hip, and osteonecrosis of the femoral head following combined periacetabular and

femoral osteotomies in a patient with Charcot-Marie-Tooth disease. Eighteen hips

(22%) had minor complications, including nonunion of the superior pubic ramus

osteotomy (five hips), a superficial stitch abscess (four), and transient

lateral femoral cutaneous nerve palsy (four). Nine hips (11%) underwent removal

of symptomatic screws, and two required a second operation to reposition the

acetabular fragment. An underlying diagnosis other than developmental dysplasia

increased the prevalence of minor complications (p = 0.0017), while a major

complication was more likely with longer surgery time, greater blood loss, and

proximal femoral osteotomy.

CONCLUSIONS: The Bernese periacetabular osteotomy is a joint-preserving

procedure that very effectively corrects acetabular dysplasia in adolescent

patients, providing improved radiographic results and a low rate of

complications. Although the rate of minor complications is increased when there

is an underlying diagnosis other than developmental dysplasia, no other

predictors were identified. However, a major complication is more likely with a

longer duration of surgery and with a concomitant femoral varus osteotomy.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a

complete description of levels of evidence.