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Complications Associated with the Periacetabular Osteotomy: A Prospective Multicenter Study

Zaltz, Ira MD; Baca, Geneva BA; Kim, Young-Jo MD; Schoenecker, Perry MD; Trousdale, Robert MD; Sierra, Rafael MD; Sucato, Daniel MD; Sink, Ernie MD; Beaulé, Paul MD; Millis, Michael B. MD; Podeszwa, David MD; Clohisy, John C. MD

Journal of Bone & Joint Surgery - American Volume: 3 December 2014 - Volume 96 - Issue 23 - p 1967–1974
doi: 10.2106/JBJS.N.00113
Scientific Articles
Supplementary Content
Disclosures

Background: The purpose of this prospective multicenter study was to determine and categorize all complications associated with the periacetabular osteotomy performed by experienced surgeons.

Methods: We prospectively analyzed perioperative complications in 205 consecutive unilateral periacetabular osteotomies performed at seven institutions by ten surgeons. All perioperative complications were recorded at an average of ten weeks and one year after surgery in standardized fashion using a validated complication grading scheme applied to hip preservation procedures. The mean patient age was 25.4 years. There were 143 female and sixty-two male patients. The most common diagnosis was developmental acetabular dysplasia, and concomitant procedures most commonly included femoral osteochondroplasty (58%) or hip arthroscopy (20%), which could include labral repair or resection.

Results: Major complications (grade III or IV) occurred in twelve patients (5.9%). Seven complications were evident at the ten-week visit and five at the one-year visit. Nine of the complications required a second surgical intervention, including repair for acetabular migration or implant adjustment (four patients), incision and drainage for a deep infection (two patients), and heterotopic bone resection, contralateral peroneal nerve decompression, and posterior column fixation (one patient each). Three thromboembolic complications were managed medically. There were no vascular injuries, permanent nerve palsies, intra-articular osteotomies and/or fractures, or acetabular osteonecrosis. The most common grade-I or II complication was asymptomatic heterotopic ossification.

Conclusions: For surgeons experienced with the periacetabular osteotomy, it is a safe procedure but is associated with a 5.9% risk of grade-III or IV complications beyond the learning curve. The majority of these complications are resolved without permanent disability.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1William Beaumont Hospital – Royal Oak, 30575 Woodward Avenue, Suite 100, Royal Oak, MI 48073

2Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for J.C. Clohisy: clohisyj@wudosis.wustl.edu

3Department of Orthopaedic Surgery, Boston Children’s Hospital, Hunnewell-2, 300 Longwood Avenue, Boston, MA 02115

4Shriner’s Hospital, Medical Staff Office, 2001 South Lindberg Boulevard, St. Louis, MO 63131

5Mayo Clinic, 200 1st Street SW E14B, Rochester, MN 55905

6Texas Scottish Rite Hospital, 2222 Welborn Street, Dallas, TX 75219

7Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

8Ottawa General Hospital, 501 Smyth Road, Suite 5004, Ottawa, ON K1H 8L6, Canada

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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