Initial Stability of the Acetabular Fragment After Periacetabular Osteotomy: A Biomechanical Study

2010 ◽  
Vol 30 (5) ◽  
pp. 443-448 ◽  
Author(s):  
Benjamin J. Widmer ◽  
Christopher L. Peters ◽  
Kent N. Bachus ◽  
Peter M. Stevens
Keyword(s):  
Periacetabular Osteotomy ◽  
Biomechanical Study ◽  
Acetabular Fragment ◽  
Initial Stability

scholarly journals Comparative Biomechanical Study of Screw Fixation Techniques in Periacetabular Osteotomy

Biomechanics ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 131-144
Author(s):  
Mahsan Bakhtiarinejad ◽  
Amirhossein Farvardin ◽  
Ryan J. Murphy ◽  
Robert B. Grupp ◽  
John E. Tis ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Developmental Dysplasia ◽  
Biomechanical Study ◽  
Pelvic Bone ◽  
Optimal Method ◽  
Yield Load ◽  
Acetabular Fragment ◽  
Significant Difference ◽  
Fixation Techniques

Periacetabular osteotomy (PAO) is a common surgical treatment for developmental dysplasia of the hip. To obtain the optimal method of fixation during PAO, different screw fixation techniques have been proposed for stabilizing the acetabular fragment. This study assesses the biomechanical performance of two popular 3-screw fixation techniques: iliac (IS) and transverse (IT) configurations, through finite element simulations. Additionally, different 2-screw combinations are simulated to investigate the biomechanical significance of each screw of the fixation configurations. The study findings show that yield load of the pelvic bone subject to gait loading for IT configuration is on average 7% higher compared to that of the IS. Although the yield load of the IT is predicted to be slightly higher, no significant difference in bone stiffness and displacement of the acetabular fragment are found between two configurations. Simulation results, therefore, do not demonstrate a significant biomechanical advantage of the IT configuration over the IS. Furthermore, the biomechanical comparison between the 2-screw combinations of IS and IT fixations demonstrates that the most anterior screw in IS, located at the iliac crest, and the most medial screw in the IT are the most critical elements in providing sufficient stability and support for acetabular fragment.

scholarly journals Periacetabular Osteotomy Performed with Imageless Computer-Assisted Navigation: Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 33-39
Author(s):  
Atul F. Kamath ◽  
Rachel R. Mays
Keyword(s):  
Surgical Navigation ◽  
Periacetabular Osteotomy ◽  
Computer Navigation ◽  
Developmental Dysplasia ◽  
Computer Assisted ◽  
Developmental Hip Dysplasia ◽  
Assisted Navigation ◽  
First Case ◽  
Acetabular Fragment ◽  
Pao Surgery

Periacetabular osteotomy (PAO) is an effective surgical treatment for developmental hip dysplasia. The goal of PAO is to reorient the acetabulum to increase acetabular coverage of the femoral head, as well as to reduce contact pressures within the hip joint. The primary challenge of PAO is to accurately achieve the desired acetabular fragment orientation, while maximizing containment and congruency. As key parts of the procedure are performed out of direct field of view of the surgeon, combined with this challenge of precise spatial orientation, there is a potential role for technologies such as surgical navigation. Adjunctive technology may provide information on the orientation of repositioned acetabulum and may offer a useful assist in performing PAO. Here, we present a case of developmental dysplasia of the hip treated via PAO with the addition of an imageless computer navigation device. Surgery was successful, and, at 3 months after procedure, the patient was progressing well. To our best knowledge, this is the first case using imageless computer-assisted navigation in PAO surgery.

scholarly journals Anatomical variants of the rectus femoris motor innervation

2019 ◽  
Vol 6 (2) ◽  
pp. 170-176
Author(s):  
Dominic Plante ◽  
Nicolas Janelle ◽  
Mathieu Angers-Goulet ◽  
Philippe Corbeil ◽  
Mohamad Ali Takech ◽  
...  
Keyword(s):  
Motor Nerve ◽  
Periacetabular Osteotomy ◽  
Femoral Nerve ◽  
Spatial Relation ◽  
Rectus Femoris ◽  
Direct Anterior Approach ◽  
Motor Innervation ◽  
Surgical Exposure ◽  
Acetabular Fragment ◽  
Number Of Branches

Abstract Adult periacetabular osteotomy (PAO) was originally performed through the classic Smith-Petersen approach for optimal operative visibility and acetabular fragment correction. Evolution towards an abductor-sparing technique significantly lowered the post-operative morbidity. The rectus-sparing approach represents a step further, but the innervation of the rectus femoris is theoretically more at risk. Although the topographic anatomy of the femoral nerve has been well described, it was never studied with specificity to surgical landmarks. The femoral nerve’s spatial relation with the anterior-inferior iliac spine (AIIS) and the amount of possible dissection in the rectus femoris and iliopsoas interval is uncertain. Seven formalin-preserved human cadaveric specimens without history of inguinal injury or surgery were dissected using the distal limb of an iliofemoral approach. The level of entry of motor innervation was measured and number of branches to the rectus femoris was noted. The average longitudinal distance from the AIIS to the first motor nerve to the rectus femoris was 8.6 ± 1.4 cm. The number of branches varied between 1 and 4 with the most common innervation pattern being composed of two segments. Dissection medial to the rectus femoris should not be carried out further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously. The clinical efficiency of the rectus-sparing approach should be studied further in order to confirm its advantage over the classic direct anterior approach. The study provides a better understanding of the localization and the anatomical variations of the structures encountered at the level of and below the AIIS. It also assesses the relative risk of denervation of the rectus femoris during PAO through the rectus-sparing approach. The authors recommend that the dissection medial to the rectus femoris should be carried out no further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously.

A Less Invasive Approach to Periacetabular Osteotomy Improves Patient Reported Outcomes without Compromising Orientation

2017 ◽  
Vol 01 (02) ◽  
pp. 093-098
Author(s):  
Christopher Pelt ◽  
Nathaniel Wingert ◽  
Jill Erickson ◽  
Mike Anderson ◽  
Christopher Peters
Keyword(s):  
Mental Health ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Global Mental Health ◽  
Periacetabular Osteotomy ◽  
Consecutive Series ◽  
Invasive Approach ◽  
Less Invasive ◽  
Acetabular Fragment ◽  
Patient Reported

AbstractA less-invasive modification of the approach to periacetabular osteotomy (PAO) has recently been popularized by sparing the rectus femoris origin (RS-PAO). The RS-PAO approach with its lack of intra-articular inspection and associated treatment is novel, and there are few published results on the outcomes following this technique. We report on a consecutive series of RS-PAO cases, including patient reported outcomes (PROs), acetabular fragment reorientation, and complications. We reviewed a consecutive series of 103 patients (103 procedures) who underwent RS-PAO from June 2012 to January 2016 with a mean 2-year follow-up. We collected PROs, radiographic, and clinical outcomes. PROs consisted of PROMIS (Patient Reported Outcomes Measurement Information System) measures covering the domains of physical function, mental health, and a numeric pain score (NPS). Physical function and mental health were reported as standardized T-scores. Appropriate bivariate statistics were used for the analyses. Physical function improved from a preoperative mean of 39.9 (95% confidence interval [CI], 38.0–42.0) to a postoperative value of 50.0 T-score units (95% CI, 47.01–52.7; dav = 1.2). The PROMIS global mental-health T-scores improved from a preoperative median of 45.8 (interquartile range [IQR], 41.1–50.8) to a postoperative value of 53.3 (IQR, 50.8–59.0; p < 0.001, correlation coefficient [r] = 0.77). Pain decreased from a median preoperative value of 6 (IQR, 3–8) to a postoperative value of 2 (IQR, 1–3; p < 0.001, r = 0.71). The postoperative acetabular index (AI) was within the correction goal in 75% of the cases (77/103) and lateral center-edge angle (LCEA) was within goal in 87% (90/103) of the cases. Complications included intraoperative ischial fracture (n = 1), nonunion of the superior ramus (n = 1), ischiofemoral impingement (n = 1), delayed union (n = 1), and wound dehiscence (n = 2). There have been no reoperations for intra-articular pathology. The data demonstrated that using the RS-PAO technique without concomitant intra-articular work allows for appropriate acetabular positioning as well as significant improvement in physical function, mental health, and pain with an acceptable short-term complication profile and low rate of reoperation.

scholarly journals Is transverse screw fixation really necessary in PAO?—A comparative in vivo study

2021 ◽  
Author(s):  
Vincent J Leopold ◽  
Juana Conrad ◽  
Christian Hipfl ◽  
Maximilian Müllner ◽  
Thilo Khakzad ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Fixation Technique ◽  
Acetabular Fragment ◽  
Center Edge ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. This study aims to assess the in vivo stability of fixation in PAO with and without the use of a transverse screw. We performed a retrospective study to analyse consecutive patients who underwent PAO between January 2015 and June 2017. Eighty four patients (93 hips) of which 79% were female were included. In 54 cases, no transverse screw was used (group 1) compared with 39 with transverse screw (group 2). Mean age was 26.5 (15–44) in group 1 and 28.4 (16–45) in group 2. Radiological parameters relevant for DDH including lateral center edge angle of Wiberg (LCEA), Tönnis angle (TA) and femoral head extrusion index (FHEI) were measured preoperatively, post-operatively and at 3-months follow-up. All patients were mobilized with the same mobilization regimen. Post-operative LCEA, TA and FHEI were improved significantly in both groups for all parameters (P ≤ 0.0001). Mean initial correction for LCEA (P = 0.753), TA (P = 0.083) and FHEI (P = 0.616) showed no significant difference between the groups. Final correction at follow-up of the respective parameters was also not significantly different between both groups for LCEA (P = 0.447), TA (P = 0.100) and FHEI (P = 0.270). There was no significant difference between initial and final correction for the respective parameters. Accordingly, only minimal loss of correction was measured, showing no difference between the two groups for LCEA (P = 0.227), TA (P = 0.153) and FHEI (P = 0.324). Transverse screw fixation is not associated with increased fragment stability in PAO. This can be taken into account by surgeons when deciding on the fixation technique of the acetabular fragment in PAO.

scholarly journals The use of image analysis software increases the accuracy of the periacetabular osteotomy fragment placement

2021 ◽  
Author(s):  
Alison J Dittmer Flemig ◽  
Anthony Essilfie ◽  
Brandon Schneider ◽  
Stacy Robustelli ◽  
Ernest L Sink
Keyword(s):  
Image Analysis ◽  
Periacetabular Osteotomy ◽  
Target Range ◽  
Control Group ◽  
Study Group ◽  
Analysis Tool ◽  
Analysis Software ◽  
Image Analysis Software ◽  
Acetabular Fragment ◽  
Center Edge

ABSTRACT The purpose of this study was to report on the use of image analysis technology to enhance accuracy of intra-operative imaging and evaluation of periacetabular osteotomy (PAO) correction. This was a retrospective study reporting on the first 25 cases of PAO performed with the use of an image analysis tool. This technology was used intra-operatively to assess the position of the supine coronal image in comparison to pre-operative standing images using a ratio of pelvic tilt (PT). Intra-operative PT, Tönnis angle, lateral center–edge angle (LCEA) and anterior wall index were compared to post-operative images. Post-operative radiographic parameters in the study group were compared with a control group of PAO cases performed prior to the implementation of the new software. The image analysis software was able to obtain intra-operative supine imaging that was equivalent to pre-operative standing imaging. When comparing the PAOs performed with the use of the software versus those without, the study group trended toward being more likely within the surgeon’s defined target range of radiographic values, which was statistically significant for LCEA. This tool can be used to assure the surgeon that the intra-operative image being used for surgical decision-making is representative of the functional radiograph. PAOs performed with the use of this technology showed enhanced accuracy of surgical correction for the parameters within our defined target ranges. This may increase the ability of the surgeon to place the acetabular fragment more precisely within his or her goal parameters for acetabular reorientation correction.

Initial Stability of Two Different Hip Revision Concepts. A Biomechanical Study

1999 ◽  
Vol 9 (1) ◽  
pp. 7-13 ◽  
Author(s):  
L. Palm ◽  
I. Ivarsson ◽  
S.-A. Jacobsson
Keyword(s):  
Biomechanical Study ◽  
Hip Revision ◽  
Initial Stability

scholarly journals Comparison of Initial Stability of Oblong, Large Circular, and Multiple-Plug “Snowman” Osteochondral Autografts for Elongated Focal Cartilage Lesions: A Biomechanical Study in a Porcine Model

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110449
Author(s):  
Shashank Dwivedi ◽  
Michael Kutschke ◽  
Maheen Nadeem ◽  
Brett D. Owens
Keyword(s):  
Clinical Outcomes ◽  
Maximum Load ◽  
Biomechanical Study ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Pull Out ◽  
Initial Stability ◽  
Significant Difference ◽  
Pull Out Strength

Background: Distal femoral osteochondral allograft transplantation (OAT) is an effective treatment of osteochondral lesions in the knee measuring >2 cm2 in select patients. Prior studies have demonstrated that the morphology of the plug can affect graft-host interference fit. To our knowledge, there are no data comparing the initial biomechanical stability of standard cylindrical plugs with multiple-plug and oblong-plug morphologies. Hypothesis: Large cylindrical single-plug (LCSP) and oblong single-plug (OSP) grafts will have greater pull-out strength, and therefore greater initial stability, than multiple-plug (MP) grafts in a cadaveric porcine femur model. Study Design: Controlled laboratory study. Methods: A total of 55 porcine distal femurs were divided into 3 groups—LCSP (n = 18), OSP (n = 19), and MP (n = 18)—according to the plug morphology used. The method of graft harvesting and implantation was based on technique guides for the respective implant systems. The sizes (length × width × depth) of the osteochondral defects created in each of the groups were approximately 20.2 × 20.2 × 9.4–mm for the LCSP group, 14.4 × 30.5 × 7.9–mm for the OSP group, and 14.8 × 14.8 × 9.9–mm for the MP group. Tensile testing was performed on each graft to determine pull-out strength. Results: The pull-out strength was significantly lower in the OSP group (65.7 N) versus the LCSP (133 N; P = .0005) and the MP (117.6 N; P = .001) groups. There was no statistically significant difference in pull-out strength between the LCSP and MP groups ( P = .42). There were no statistically significant differences in displacement at maximum load among any 2 of the 3 groups. Conclusion: These findings suggest that while initial stability may play a role in the clinical outcomes of osteochondral allograft (OCA) implantation, the biological milieu in vivo for each graft setting perhaps has a greater impact on the success of an OAT procedure. Further study is needed on the relationship between OCA biomechanics and clinical outcomes of OAT.

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