Reduced rates of non-union with modified periacetabular osteotomy using peracetic-acid sterilized cancellous allografts
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Reduced rates of non-union with modified periacetabular osteotomy using peracetic-acid sterilized cancellous allografts Georgi I. Wassilew . Viktor Janz . Lisa Renner . Carsten Perka . Axel Pruss
Received: 9 May 2016 / Accepted: 27 September 2016 / Published online: 18 October 2016 Ó Springer Science+Business Media Dordrecht 2016
Abstract The objective of the present study was to analyze the clinical and radiological results of periacetabular osteotomies (PAO) using Kirschner wire fixation and an allogeneic cancellous bone graft. This retrospective cohort study included 73 patients (85 PAOs). The allografts were processed from distal femur of cadaveric donors, defatted, sterilized with a peracetic-acid ethanol solution and freeze-dried. The clinical outcome, as measured by the Harris Hip Scores (HHS), the complication rate and the acetabular correction, as measured by radiological parameters, were compared. The postoperative femoral head coverage and HSS were significantly improved. Major complications occurred in five cases (6 %), but in no case did we observe a non-union or a graft-associated adverse effect. Fixation of the acetabular fragment with Kirschner wires in combination with an allogeneic cancellous bone graft is a safe method, with a low complication rate, no loss of correction and can prevent the occurrence of non-union with a high degree of probability.
G. I. Wassilew (&) V. Janz L. Renner C. Perka Orthopedics Department, Center for Musculoskeletal Surgery, Charite´ - Universita¨tsmedizin Berlin, RahelHirsch-Weg 5, 10117 Berlin, Germany e-mail: [email protected] A. Pruss University Tissue Bank, Institute of Transfusion Medicine, Charite´ - Universita¨tsmedizin Berlin, Berlin, Germany
Keywords Periacetabular osteotomy Kirschner wire Allografts Peracetic acid Tissue bank
Introduction The treatment of adult hip dysplasia (DDH) was significantly improved by the development of the Bernese periacetabular osteotomy (PAO) (Ganz et al. 1988). The technical advantages of the PAO compared to other hip osteotomies include more rapid mobilization by sparing the posterior column, reorientation of the acetabulum through a single incision, preservation of acetabular blood supply and of the internal pelvic diameter, allowing for natural childbirth (Leunig and Ganz 2014; Thawrani et al. 2010). Excellent radiological and clinical results have been described in short-term, mid-term and long-term follow-up (Ganz et al. 1988; Clohisy et al. 2007; Matta et al. 1999; Kralj et al. 2005). The most common major complication is the development of non-union, with a reported incidence as high as 19 % (Clohisy et al. 2005, 2007; Matta et al. 1999; Kralj et al. 2005; Biedermann et al. 2008; Crockarell et al. 1999; Cunningham et al. 2006; Mayo et al. 1999; Peters et al. 2006; Sen et al. 2003; Siebenrock et al. 1999; Trousdale et al. 1995; Trumble et al. 1999). The causes of non-union include the large forces affecting the hip joint upon mobilization (Stuby et al. 2014; Tscherne and Pohlemann 1998), the relat
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