Purpose
Periacetabular osteotomy (PAO) has become an accepted treatment option for patients
with severe hip dysplasia. In addition to correcting acetabular architecture, consideration
has been given to concomitant joint evaluation and treatment of coexisting intra-articular
pathologic conditions, which can be identified with hip arthroscopy or through an
open arthrotomy. The purpose of this systematic review was to evaluate the prevalence
of intra-articular pathologic conditions identified arthroscopically compared with
that of those identified with open arthrotomy.
Methods
A systematic review of the literature was performed by a search of PubMed using the
words “periacetabular osteotomy,” “Bernese osteotomy,” and “Ganz osteotomy.” Two reviewers
searched for relevant articles that met established inclusion criteria, which follow:
(1) they were in the English language, (2) they contained data on patients who underwent
periacetabular osteotomy, (3) the study patients underwent concomitant arthroscopy
or arthrotomy, and (4) the studies contained data on the intra-articular findings
at the time of osteotomy. Exclusion criteria included review articles, technique articles,
articles reporting on the same patient population, and articles without reported patient
data.
Results
After review of 361 references and abstracts, 8 articles met the inclusion criteria.
A total of 775 patients who had undergone PAO were included in the 8 articles. Three
articles inspected all joints at the time of PAO and accounted for 345 PAOs. Arthrotomy
was used to evaluate 151 hips, and 31 (21%) labral tears were identified. Arthroscopy
was used to evaluate 194 hips, and 162 (84%) labral tears were identified. The difference
in prevalence is statistically significant (P < .05). Two of the 3 articles reported chondral injury: 141 (73%) acetabular chondral
injuries and 52 (27%) femoral chondral injuries were noted in 194 hips.
Conclusions
The prevalence of intra-articular damage, including labral injuries and pathologic
conditions of cartilage, at the time of PAO is substantial. Labral tears and chondral
injury appear to be better recognized with concomitant arthroscopy when compared with
arthrotomy at the time of PAO. Further study is needed to determine whether the treatment
of chondrolabral injuries can improve patient outcome and reduce reoperations.
Level of Evidence
Level IV, systematic review of Level IV studies.
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References
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Article info
Publication history
Published online: January 24, 2014
Accepted:
November 12,
2013
Received:
October 21,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: C.E.S. receives support from MAKO Surgical Corporation; B.G.D. receives support from American Hip Institute, Arthrex, MAKO Surgical Corporation, Pacira, Breg, ATI, OrthoMerica, DJO Global, and Stryker.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
