Three-dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position us
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ORTHOPAEDIC SURGERY
Three‑dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position using an external fixator as navigation tool during reorientation procedure Timo J. Schwarz1 · Günther Maderbacher1 · Franziska Leiss1 · Joachim Grifka1 · G. Heers2 · J. Matussek3 Received: 29 March 2020 / Accepted: 30 September 2020 © The Author(s) 2020
Abstract Introduction Bernese periacetabular osteotomy is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection with residual dysplasia or femoroacetabular impingement. Thus, we wanted to find a simple method to control the effect of correction in the sagittal and coronal plane. Method The acetabular coordinates are shown by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the acetabular fragment with two Schanz screws. This method enables the isolated acetabular reorientation in the coronal, sagittal, and transverse plane. In a sawbone pelvis model, the acetabular rim is marked with a copper wire and a silicon adherent. To show the radiographic effect on acetabular parameters and the rim position, we visualized correction in the coronal and sagittal plane under fluoroscopic control. Results Lateral rotation of the acetabular fragment had the highest impact on radiographic lateral coverage of the femoral head. But also ventral coverage increased during isolated lateral rotation. Anterior rotation showed almost no effect on lateral coverage and just a little effect on ventral coverage but caused severe total acetabular retroversion. Conclusion Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and under-correction. Isolated lateral rotation of the acetabular fragment should be the predominant direction of correction during periacetabular osteotomy. Ambitious anterior correction may be the main source for severe acetabular retroversion following periacetabular osteotomy. Keywords Periacetabular osteotomy · Retroversion · Dysplasia · Hip surgery · Impingement · Navigation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00402-020-03632-y) contains supplementary material, which is available to authorized users. * Timo J. Schwarz [email protected]; [email protected] Günther Maderbacher [email protected]‑regensburg.de Franziska Leiss [email protected] Joachim Grifka [email protected] G. Heers gheers@t‑online.de
1
Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser‑Karl‑V.‑Allee 3, 93077 Bad Abbach, Germany
2
Department of Orthopedic Surgery and Arthroplasty, Vitos Orthopedic Clinic Kassel, Wilhelmshöher Allee 345, 34131 Kassel, Germany
3
Departement of Pediatric Orthopedic Surgery, Klinikum Emil von Behring, Academic Teaching Hospital of Charite Berlin, Walterhöferstr. 11, 14165 Be
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