Fewer failures treating hip dysplasia with Bernese osteotomy

Nine of 11 major complications occurred in the first 34 patients treated, underscoring the procedure's learning curve.

Surgical correction of acetabular dysplasia using Bernese periacetabular osteotomy results in lower failure rates over the short-term compared with triple innominate osteotomy, according to a study by Utah surgeons.

Christopher L. Peters, MD, and colleagues at the University of Utah Orthopaedic Center in Salt Lake City prospectively evaluated their results performing the procedure over six years. The study included 83 hips among 73 patients — 59 hips with classic or inverted acetabular dysplasia and 24 hips with retroverted acetabular dysplasia. In all cases, Peters performed the surgery using a Smith-Petersen approach.

Follow-up averaged 36 months (range 24 to 82 months), according to the study.

Postoperatively, the Harris Hip Score improved from a mean of 54 to a mean of 87. Hip score did not significantly differ between patients with initially inverted hips and those with retroverted hips, said Peters, who presented the results at the 118th Annual Meeting of the American Orthopaedic Association, held in Huntington Beach, Calif.

Center Edge Angle (CEA), evaluated radiographically, improved an average of 20°, from a preoperative mean of 4° to 30° postoperatively. Anterior CEA improved an average of 26°, from a mean of 6° at preop to 31° postop, according to the study.

“We had what we considered 11 major complications — three femoral nerve palsies, which resolved; one sciatic nerve irritation, which also resolved; four hematomas; and three deep infections,” Peters said.

“Because this is a technically difficult operation, [we wanted to look] at our complications and see if there was any relationship to the learning curve,” he said.

“When we look at those 11 complications, nine of those occurred in the first 34 cases, and only two major complications in the last 49 cases,” he said. “The results confirm the significant learning curve.”

Radiography showed no osteoarthritis progression in 58 hips. Twenty-three hips showed one grade of progression and two hips showed two grades of progression, he noted.

During follow-up, four patients were considered failures; one patient required a revision osteotomy and three patients required total hip replacement less than four years after the initial osteotomy. This yields a survivorship rate of 95% at 36 months (P=.08), Peters said.

Comparatively, a previous study evaluating triple innominate osteotomy performed by Peters and colleagues found 16 of 60 hips (27%) failed at a mean follow-up of nine years, according to the study. Peters subsequently switched to performing Bernese periacetabular osteotomy in 1996, he said.

For more information:
Peters CL, Erickson JA, Hines J. Evolution of acetabular redirectional osteotomy at an academic center: early results with the Bernese periacetabular osteotomy. #AR1. Presented at the 118th Annual Meeting of the American Orthopaedic Association. June 22-25, 2005. Huntington Beach, CA.