Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 11

Surgical Anatomy of Bernese Periacetabular Osteotomy Modified Approach. A Cadaveric Study

Dante Parodi1, José Tomás Bravo1*, Javiera González2, Diego Villegas1 and Carlos Tobar1

1Clinica Redsalud Providencia, Santiago Chile
2Universidad Finis Terrae, Santiago, Chile

*Corresponding Author: José Tomás Bravo, Clinica Redsalud Providencia, Santiago Chile.

Received: September 19, 2022; Published: October 07, 2022

Abstract

Introduction: The Bernese periacetabular osteotomy (PAO) is one of the most widely used surgical techniques in hip dysplasia. Several modifications in the approach have been described in the literature. The iliocapsularis muscle is a valuable landmark in the PAO approach, owing to its constant presentation and being an element that may help protect neurovascular structures.

Objective: This study aims to describe this surgical technique through an anatomical-cadaveric study performing a split incision of the Iliocapsularis muscle and show the clinical results regarding the care of the motor branch of the femoral nerve and the lateral femoral circumflex artery.

Surgical technique: One cadaveric specimen was used for the cadaveric dissection. An oblique inguinal incision is performed. An anterior superior iliac spine osteotomy keeping the sartorius insertion intact is performed. The rectus femoris muscle is exposed, keeping its direct and reflex insertions intact. The iliocapsularis is dissected into two halves: a lateral one that remains in its position and a medial one that is rejected medially which protects the motor branch of the femoral nerve). Subsequent osteotomies described according to the original technique are carried out.

Methods: Prospective Cohort of patients with hip dysplasia operated by the same surgeon using the current technique between June 2016 and July 2022. A directed physical examination was performed to evaluate the motor branch of the femoral nerve on the first postoperative day, and then during the follow-up period.

Results: 88 Bernese periacetabular osteotomies, no patients were excluded. 63.4% females, 27.7 (15-49) years old, 47.5 months (3-75) follow-up. One femoral nerve neuropraxia was secondary to a hematoma, which resolved completely. One self-limited paresthesia was detected in the territory of the lateral femoral cutaneous nerve.

Conclusion: Iliocapsularis split dissection provides adequate protection for the motor branch of the femoral nerve and the lateral femoral circumflex artery.

Keywords: Surgical; Bernese Periacetabular; Osteotomy

References

  1. Wilkin GP., et al. “A Contemporary Definition of Hip Dysplasia and Structural Instability: Toward a Comprehensive Classification for Acetabular Dysplasia”. The Journal of Arthroplasty 9S (2017): S20-S27.
  2. Gala L., et al. “Hip Dysplasia in the Young Adult”. The Journal of Bone and Joint Surgery1 (2016): 63-73.
  3. Ganz R., et al. “A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results”. Clinical Orthopaedics 232 (1988): 26-36.
  4. Steppacher S., et al. “Mean 20-year follow-up of Bernese periacetabular osteotomy”. Clinical Orthopaedics and Related Research 466 (2008): 1633-1644.
  5. Matheney T., et al. “Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome”. The Journal of Bone and Joint Surgery. American 9 (2009): 2113-2123.
  6. Kralj M., et al. “The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7-15-year follow-up of 26 hips”. Acta Orthopaedica 6 (2005): 833-840.
  7. Millis MB and Mc Clincy M. “Periacetabular osteotomy to treat residual dysplasia in adolescents and young adults: indications, complications, results”. Journal of Children’s Orthopaedics 4 (2018): 349-357.
  8. Clohisy JC., et al. “A Systematic Approach to the Plain Radiographic Evaluation of the Young Adult Hip”. The Journal of Bone and Joint Surgery-American4 (2008): 47-66.
  9. Thomas GER., et al. “Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20-year longitudinal cohort study”. Osteoarthritis and Cartilage 10 (2014): 1504-1510.
  10. Kalhor M., et al. “Surgical Anatomy of the Rectus-Sparing Approach for Periacetabular Osteotomy: A Cadaveric Study”. JBJS Essential Surgical Techniques 2 (2021): e20.00030.
  11. Lara J., et al. “Oblique Inguinal Incision inBernese Periacetabular Osteotomy: Surgical Technique”. Journal of the American Academy of Orthopaedic Surgeons. Global Research and Reviews 9 (2017): e061.
  12. Lara J., et al. “Bernese periacetabular osteotomy for hip dysplasia. A modification to original technique and South American perspective”. Current Reviews in Musculoskeletal Medicine 4 (2014): 337-341.
  13. Kamath AF. “Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications”. World Journal of Orthopedics 5 (2016): 280-286.
  14. Ward WT., et al. “Anatomy of the iliocapsularis muscle. Relevance to surgery of the hip”. Clinical Orthopaedics and Related Research 374 (2000): 278-285.
  15. Mac Dermott KD., et al. “Anatomical features of the iliocapsularis muscle: a dissection study”. Surgical and Radiologic Anatomy 4 (2022): 599-608.
  16. Babst D., et al. “The iliocapsularis muscle: an important stabilizer in the dysplastic hip”. Clinical Orthopaedics and Related Research 6 (2011): 1728-1734.

Citation

Citation: José Tomás Bravo., et al. “Surgical Anatomy of Bernese Periacetabular Osteotomy Modified Approach. A Cadaveric Study". Acta Scientific Orthopaedics 5.11 (2022): 39-44.

Copyright

Copyright: © 2022 José Tomás Bravo., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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