Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia
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ORIGINAL PAPER
Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia Hiroshi Imai 1 & Tomomi Kamada 1 & Joji Miyawaki 1 & Akira Maruishi 1 & Naohiko Mashima 1 & Hiromasa Miura 1 Received: 27 December 2019 / Accepted: 17 April 2020 # The Author(s) 2020
Abstract Aim of the study To compare the outcomes after computer-assisted peri-acetabular osteotomy (PAO) and conventional PAO performed for hip dysplasia (DDH). Methods Ninety-one patients (98 hips) were enrolled in this study. In each case, DDH was treated with either conventional PAO, in which the angle and direction of the osteotomy was determined by intra-operative X-ray examination, or with computerassisted PAO, which used the 3D navigation system. Forty hips underwent conventional PAO and 58 hips underwent computerassisted PAO. Results Japanese Orthopaedic Association hip scores improved significantly from 70.0 points pre-operatively to 90.7 points postoperatively in patients with conventional PAO, and from 74.5 points pre-operatively to 94.2 points post-operatively in patients with computer-assisted PAO. In all patients with computer-assisted PAO, the post-operative AHI and VCA angle were within the radiographic target zone. Some patients with conventional PAO had post-operative AHI and VCA angle outside of the target zone. We performed total hip arthroplasty (THA) on five of the 98 PAO hips (5.1%) after an average follow-up period of 5.4 years. None of 58 hips (0%) with computer-assisted PAO was revised. Discussion Computer-assisted PAO enabled intra-operative confirmation of osteotomy sites, and the position of the osteotomized bone fragment could be confirmed in real time. Adequate anterior and lateral coverage of the femoral head in patients with computer-assisted PAO resulted in no need for early conversion to THA, in contrast to conventional PAO. Conclusion Computer-assisted PAO not only improved accuracy and safety but also achieved sufficient anterior and lateral displacement to prevent the progression of DDH. Keywords Developmental dysplasia of the hip . Computer-assisted periacetabular osteotomy . Clinical and radiographic outcomes . Adequate anterior and lateral acetabular coverage
Introduction Developmental dysplasia of the hip (DDH) is a frequent cause of secondary osteoarthritis (OA). It is also the leading cause of end-stage OA of the hip in patients younger than 50 years. Peri-acetabular osteotomy (PAO), which includes rotational acetabular osteotomy (RAO) [1], eccentric rotational
Level of Evidence: Level 4, retrospective study * Hiroshi Imai [email protected] 1
Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
acetabular osteotomy (ERAO) [2], Bernese peri-acetabular osteotomy (PAO), and curved peri-acetabular osteotomy (CPO) [3, 4], aims to correct the deficient acetabular coverage in hips with DDH so as to prevent secondary OA. It is difficult, however, to obtain adequate acetabular coverage of the fe
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