Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study

Triple Pelvic Osteotomy for Hip Dysplasia: The Akbulut-Coskun Technique Using a Modified Stoppa Approach

BACKGROUND

Many successful osteotomies have been reported for the treatment of acetabular dysplasia. However, triple pelvic osteotomy remains a technically challenging procedure with potential for significant complications. This study examined a series of Tönnis periacetabular osteotomy (TPAO) procedures performed using the modified Stoppa approach to treat acetabular dysplasia in adolescents.

OBJECTIVE

To describe the radiographic outcomes, complications, and early functional results of TPAO using the modified Stoppa approach for acetabular dysplasia in adolescents.

METHODS

This study included 16 patients (20 hips) who underwent TPAO using the modified Stoppa approach for symptomatic acetabular dysplasia. The characteristics of the patients and the surgical procedure were discussed. The radiologic outcome was evaluated using the lateral center-edge (CE) and Tönnis roof angles. Perioperative data including surgery duration, blood loss, and complications were recorded. Complications were also discussed.

RESULTS

The mean age of the patients was 11.5±1.1 (10 to 13) years. The mean preoperative anteroposterior CE angle was 14.7±3 degrees (7 to 19 degrees), and the mean postoperative angle was 35.7±3.1 degrees (30 to 42 degrees; P <0.001). The mean preoperative Sharp's angle was 55.9±5.4 degrees (48 to 65 degrees), and the postoperative mean was 33±5 degrees (24 to 40 degrees; P <0.001). The mean Tönnis angle before and after osteotomy was 23.3±7.1 degrees (17 to 36 degrees) and 7.1±2 degrees (4 to 10 degrees), respectively ( P <0.001). The mean operative time was 42.2±10.3 minutes with a mean blood loss of 167.7±50.3 mL. One patient sustained a bladder injury as a major complication.

CONCLUSIONS

The use of TPAO with the intrapelvic modified Stoppa approach in the treatment of hip dysplasia provides the benefits of a single incision, access to 2 hips in the same session, positional advantage, and abductor function preservation. Early results are satisfactory and safe.

LEVEL OF EVIDENCE

Level IV.

Functional and radiological outcomes and complications of Bernese periacetabular osteotomy through modified Stoppa approach

BACKGROUND

The Smith-Peterson approach and its modifications provide an extensive exposure and allow osteotomies through a single incision. However, the risk of complications increases when the quadrilateral surface, ischial and pubic osteotomy sites cannot be seen. This study aimed to evaluate the surgical characteristics, complications, and functional and radiological outcomes of patients with acetabular dysplasia who underwent Bernese periacetabular osteotomy (PAO) through modified Stoppa approach and plate-screw fixation.

METHODS

The study included 31 patients (41 hips) who had undergone PAO using a modified Stoppa approach. The characteristics of patients and the surgical procedure were described. The lateral centre-edge angle (LCEA) and Tönnis roof angle were evaluated in the radiological outcome evaluation. The modified Harris Hip Score (mHHS) was used to evaluate functional outcome. Furthermore, complications were described.

RESULTS

The mean age of the patients was 20.4 ± 9.0 years. Of the 31 patients, 21 underwent unilateral Bernese PAO and 10 underwent bilateral Bernese PAO. The mean follow-up period was 25.1 ± 8.8 months. Postoperatively, the mean mHHS improved significantly (68.8 ± 9.4 vs. 88.8 ± 10.0, p < 0.001). Postoperatively, the mean LCEA and Tönnis roof angle improved significantly (17.7 ± 6.0 vs. 42.2 ± 4.8, p < 0.001 for LCEA and 18.3 ± 5.5 vs. 8.0 ± 2.2, p < 0.001 for Tönnis roof angle). There was no significant correlation between preoperative to postoperative improvement in LCEA or Tönnis roof angle and improvement and mHHS (p > 0.005). 5 complications were identified: 1 transient sciatic nerve palsy, 1 external iliac vein injury, 1 infection, and 2 screw irritations of acetabulum.

CONCLUSIONS

Performing Bernese PAO through a modified Stoppa approach with plate-screw fixation results in acceptable complication rates, immediate early weight-bearing opportunity, and improved functional and radiological outcomes in patients with acetabular dysplasia.

Comparison of Two Surgical Approaches for Periacetabular Osteotomy: A Retrospective Study of Patients with Developmental Dysplasia of the Hip

OBJECTIVE

Given the intricate challenges and potential complications associated with periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH). Our study aimed to compare the clinical and imaging benefits and drawbacks of two surgical approaches, the modified Stoppa combined iliac spine approach and the modified Smith-Peterson approach, for treating PAO and to provide guidance for selecting clinical approaches.

METHODS

A retrospective analysis of 56 patients with 62 DDHs was conducted from June 2018 to January 2022. The experimental group underwent surgery via the modified Stoppa combined iliac spine approach, while the control group underwent surgery via the modified Smith-Peterson approach for periacetabular osteotomy and internal fixation. Basic statistical parameters, including age, sex, BMI, and preoperative imaging data, were analyzed. Differences in surgical time, intraoperative blood loss, and postoperative imaging data were compared, as were differences in preoperative and postoperative imaging data between the two groups.

RESULTS

There were 28 hips in the experimental group and 34 in the control group. Moreover, there was no significant difference in the basic parameters between the experimental and control groups. Before and after the operation, for the LCE angle, ACE angle, and Tonnis angle, there was no significant difference in acetabular coverage (p > 0.05). However, there were significant differences between the two groups in terms of the above four indicators before and after the operation (p < 0.05). After the operation, the experimental group exhibited significant increases in both lateral and anterior acetabular coverage of the femoral head. However, the experimental group had longer operation times and greater bleeding volumes than did the control group. Despite this, the experimental group demonstrated significant advantages in protecting the lateral femoral cutaneous nerve compared to the control group.

CONCLUSION

The modified Stoppa combined iliac spine approach can be considered a practical approach for PAO and is more suitable for patients with DDH who plan to be treated by one operation than the classic modified Smith-Peterson approach for PAO.

Periacetabular osteotomy: A novel application of modified Stoppa approach

BACKGROUND

The Bernese periacetabular osteotomy (PAO) is a well-established procedure for symptomatic hip dysplasia in adolescents and young adults. However, it remains a technically demanding procedure, and several major complications have been described, many of which are related to the approach and surgical exposure. The current study evaluates the efficacy and safety of PAO performed through a modified Stoppa approach.

METHODS

A prospective series of nine consecutive patients with hip dysplasia were treated PAO through the modified Stoppa approach. The mean age was 22.4 years (15-30 years) and the mean follow-up was 3.2 years (2-5 years). Harris hip score (HHS) was used as a functional score, and the radiographic indices included the lateral center-edge angle (LCEA) and Tönnis roof angle.

RESULTS

The approach allowed the osteotomy lines to be performed under direct visualization from the intra-pelvic surface of the acetabulum, aided by fluoroscopy. A lateral window was added to perform the final iliac cut and for subsequent mobilization and fixation of the acetabular fragment. The mean HHS improved significantly from 70.8 ± 4.9 points to 90.1 ± 3.3 points (p < 0.001). The mean LCEA improved from 8.2° ± 4.9 (range: 0-14) to 32.7° ± 5.3 (range: 26-40), with a mean improvement of 24.5°. The mean Tönnis angle improved from 28.4° ± 4.4 (range: 22-35) to 3.8° ± 3.3 (range: 0-10). Two patients had irritation from prominent screw heads that necessitated removal 1 year after the index procedure. One patient had radiographic progression of osteoarthritis. No cases of infection, non-union, heterotopic ossification, or nerve palsy were identified till the latest follow-up.

CONCLUSION

Ganz PAO can be safely conducted through the modified Stoppa approach, providing direct exposure to the osteotomized surfaces, and protecting susceptible neuro-vascular structures.

LEVEL OF EVIDENCE

IV.

Ganz osteotomy for treatment of hip dysplasia through intra-pelvic approach. Early results

Ganz periacetabular osteotomy (PAO) is a technically demanding surgical procedure. It requires cutting around the acetabulum to mobilize it under fluoro- scopic control. The radiolucent table and good quality imaging are mandatory to perform this osteotomy in a safe way. Modification of Ganz osteotomy was developed a with minimal soft tissue exposure using intra-pelvic approach which allows direct visualization of the quadrilateral plate. The purpose of the present study was to review the early results in the initial group of patients who had this procedure. The Ganz PAO was performed on 8 cases painful dysplastic hips, using the intra-pelvic approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. The acetabular fragment was medialized and redirected anterolaterally then fixed with 3 screws. The pre-operative Harris hip score mean was 66.8 and improved to be 92.7 (p value <0.0005) and this was statistically significant. Radiologically the CEA improved in the pre-operative X-ray from mean of 13.12 degree to 28.37 degrees (p value <0.0005) and this was statistically significant. Painful dysplastic hips should be treated before function becomes seriously impaired. The Ganz osteotomy through an intra-pelvic approach, can be done with minimal exposure to radiation in a relatively short time.

Novel Utilization of Anterior Intrapelvic (Stoppa) Approach for Periacetabular Ganz Osteotomy: A Report of 2 Cases

CASE

The Ganz periacetabular osteotomy (PAO) is widely used to correct developmental hip dysplasia in the adolescent and young adult population. The aim of this case study was to examine the novel utility and safety of Stoppa approach for the Ganz PAO in a 15-year-old girl and 25-year-old man. The Stoppa approach is traditionally used for acetabular fractures, and its use for a Ganz PAO is relatively novel.

CONCLUSION

The Stoppa approach allows surgeons to successfully perform the Ganz PAO while simultaneously providing direct visualization for all osteotomies and vital structures.

Periacetabular osteotomy for hip dysplasia treatment through a mini-invasive technique. Our results at mid-term in 131 cases

BACKGROUND AND OBJECTIVE

Periacetabular osteotomy (PAO) is an accepted and worldwide technique recognized for residual dysplasia treatment and even in unstable hips with limited acetabular coverage. The aim of this study is to analyse the functional, radiological and complication results in patients treated with mini-invasive PAO.

MATERIAL AND METHODS

We performed a retrospective study in which we analysed 131 cases undergoing mini-invasive PAO at our centre. The degree of joint degeneration was evaluated with Tönnis scale, Wiberg angle, acetabular index (AI), anterior coverage angle (AC), joint space, complications and functional outcome with the Non-Arthritic Hip Score (NAHS) were analysed preoperatively and at the end of follow-up.

RESULTS

The average age was 32.3±9.5 (SD) years, 102 (77.9%) were female and 29 (22.1%) were male. 7.7±2.8 (SD) years follow up. The radiological parameters improved between the pre-surgical phase and the end of follow-up, Wiberg angle+18.5° (18.3° versus 36.8°, 95% CI 17.3 to 19.7), AC angle+13.5° (26.2° versus 39.7°, 95%CI 11.6 to 15.4) and the AI -11.1° (19.5° versus 8.4°; 95%CI -12.1 to -10,1). In addition, the functional results, with the NAHS scale, improved+31.3 points (60.7 pre-surgical versus 92 at the end of follow-up, 95% CI 28.7 to 33.8). The most common complication was transient lateral femoral cutaneous nerve hypoaesthesia in 10 cases (7%).

CONCLUSION

The mini-invasive PAO approach is a reproducible technique, it allows restoration of acetabular coverage and provides an improvement in functional scales as confirmed by our series.

Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles

INTRODUCTION

Herein, we describe and evaluate a curved periacetabular osteotomy (CPO) via an intermuscular approach (IM-CPO) between the sartorius and iliac muscles.

METHODS

Between January 2009 and January 2016, IM-CPO was performed in 17 joints (16 patients), and a traditional CPO was performed in 17 joints. The length of incision at wound closure, operative time, intraoperative blood loss, serum creatinine kinase (CK) level the day after surgery, correctional angle, walking ability assessed using the gait items of the Harris Hip Score (at 3 and 6 months after surgery), and perioperative complications were evaluated. Group differences were assessed using t-tests.

RESULTS

The IM-CPO and CPO groups did not differ in the mean operative time (130 minutes and 124 minutes, respectively), mean serum CK the day after surgery (349 IU/L and 425 IU/L, respectively), or mean correctional angle (24.9° and 24.6°, respectively). The mean incision length was significantly shorter in the IM-CPO group (8.3 cm) compared to that in the CPO group (9.5 cm). The mean walking ability was significantly higher in the IM-CPO group (24.2 points) compared to that in the CPO group (20.9 points) at 3 months after surgery, but not at 6 months after surgery (26.4 points and 24.9 points, respectively). No serious complications were observed in either group.

CONCLUSION

In addition to demonstrating a similarly satisfactory correctional angle, IM-CPO is anticipated to enable early weight-bearing and recovery of walking ability. Thus, IM-CPO is considered a superior surgical technique.