Bernese Periacetabular Osteotomy for Hip Dysplasia

Bernese Periacetabular Osteotomy for Hip Dysplasia- Salomi R. Vora

Progression of Hip Dysplasia1

IntroductionThe Bernese Periacetabular Osteotomy (BPO) was developed in 1984 and was published in 1988.2This 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

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.3Advantages of Osteotomy:

4Advantages of BPO:3

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

5Criteria 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)

1. Probably due to increased degenerative changes in elderly patients.2.Many patients do not meet the criteria of No arthrosis (Murphy & Deshmukh, 2002.)6

Functional Measures for Follow up1 WOMAC score

Tonnis Classification for OA

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)9Functional OutcomeStudy 1:

Population = 24 patientsFollow up duration = mean of 3.5 yearsResults = 18 out of 24 patients showed high functional level on follow up.4

10Study 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

Post Operative Therapy Recommendations1,3Mobilization with partial weight bearing (20- 40 pounds)- 3 days.

AROM Exercises with > 90 - 4 weeks

Total weight bearing 6-8 weeks.

ResourcesWOMAC score: http://www.rheumatology.org/Practice/Clinical/Clinicianresearchers/Outcomes_Instrumentation/Western_Ontario_and_McMaster_Universities_Osteoarthritis_Index_(WOMAC)/Tonnis classification for OA: http://www.preventivehip.org/hip-scores/tonnis-classification

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ReferencesKralj 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.

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.

Trousdale R, Cabanela M. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthopaedica Scandinavica. April 2003;74(2):119.

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.