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The minimal invasive periacetabular osteotomy (PAO) for adult hip dysplasia surgical tips and tricks

Published in N°006 - July / August 2020
Article viewed 141 times

The minimal invasive periacetabular osteotomy (PAO) for adult hip dysplasia surgical tips and tricks

By GI Wassilew, V. Janz, J. Löchel, A. Hofer, R. Kasch in category SURGICAL TECHNIQUE
Greifswald University Hospital, Fleischmannstraße 6, 17489 Greifswald, Germany / [email protected]

In 1988, Ganz et al. first described the surgical procedure of periacetabular osteotomy (PAO) for acetabular reorientation. PAO is an extensive surgical procedure performed in young adults with symptomatic DDH to improve function of the hip joint and delay the development of secondary osteoarthritis.

Introduction

In 1988, Ganz et al. first described the surgical procedure of periacetabular osteotomy (PAO) for acetabular reorientation. PAO is an extensive surgical procedure performed in young adults with symptomatic DDH to improve function of the hip joint and delay the development of secondary osteoarthritis. The goals of acetabular reorientation are to optimize femoral head coverage, normalize joint mechanics and reduce the risk of secondary osteoarthritis.

Prior to the development of the PAO, the triple osteotomy was the primary procedure for acetabular reorientation to treat symptomatic DDH in skeletally mature patients 1. The technical advantages of PAO compared to the triple osteotomy include increased postoperative stability through preservation of the continuity of the posterior acetabular column, allowing for faster mobilisation, protection of the acetabular perfusion and preservation of the internal pelvic diameter, allowing for normal child birth 2 3 4.

While the original surgical technique of the PAO required an extensive skin incision and detachment of both the Sartorius and Rectus femoris muscle origins, newer minimally invasive surgical techniques allow for singular and shorter skin incisions (bikini incision), preservation of muscular attachments and...

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