SpringerLink
Log in

The Bernese periacetabular osteotomy

  • Published:
Orthopedics and Traumatology

Abstract

Objective

A dysplastic acetabulum inadequately covering the femoral head is freed from the bony pelvis through several osteotomy cuts close to the joint, properly positioned and fixed with three screws.

Indications

Symptomatic acetabular dysplasia with closed physes.

Osteoarthritis Tönnis stage ≤2.

Improved coverage on abduction view.

Contraindications

Dislocation.

Neoacetabulum.

Worsening of congruence in abduction.

Osteoarthritis Tönnis stage 3.

Surgical Technique

Modified Smith-Petersen approach. Incomplete osteotomy of the ischial ramus. Complete osteotomy of the pubic ramus. Supra- and retroacetabular osteotomies: perpendicular osteotomy directly below the anterosuperior iliac spine ending short of the linea terminalis, continuing in direction of the ischial spine. Osteotomy 4 cm below the linea terminalis, connecting to the ischial osteotomy. Mobilization and reorientation. Radiographic control. Anterior capsulotomy: check for labral and chondral pathology, and im**ement. Fixation with three 3.5-mm cortical screws. Reconstruction of the detached structures.

No cast or orthosis. Touch weight bearing for 8 weeks, then abductor strengthening.

Results

Of the first 63 patients, 60 (71 hips) were followed for 10–14 years. 58 hip joints were still preserved (82%), and function was excellent to good in 52 (73%). Negative prognostic factors were advanced age, osteoarthritis, and insufficient correction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aronson J. Osteoarthritis of the young adult hip: etiology and treatment. In: The American Academy of Orthopaedic Surgeons, ed. Instructional Course Lectures, Vol 35. St. Louis: Mosby, 1986:110–28.

    Google Scholar 

  2. Carlioz H, Khouri N, Hulin P. Osteotomie triple juxtacotyloidienne. Rev Chir Orthop 1982;68:497–501.

    PubMed  CAS  Google Scholar 

  3. Chiari K. Ergebnisse mit der Beckenosteotomie als Pfannendachplastik. Z Orthop 1955;87:14–26.

    PubMed  CAS  Google Scholar 

  4. Cooperman DR, Wallenstein R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop 1983;175:79–85.

    PubMed  Google Scholar 

  5. Crockarell J Jr, Trousdale RT, Cabanela ME, Berry DJ. Early experience and results with the periacetabular osteotomy. Clin Orthop 1999;363:45–53.

    PubMed  Google Scholar 

  6. D’Aubigné RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:451–75.

    PubMed  Google Scholar 

  7. Davey JP, Santore RF. Complications of periacetabular osteotomy. Clin Orthop 1999;363:33–7.

    PubMed  Google Scholar 

  8. Eppright RH. Dial osteotomy of the acetabulum in the treatment of dysplasia of the hip. J Bone Joint Surg Am 1975;57:1172.

    Google Scholar 

  9. Flückiger G, Eggli S, Kosina J, Ganz R. Geburt nach periazetabulärer Osteotomie. Orthopäde 2000;29:63–7.

    PubMed  Google Scholar 

  10. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Clin Orthop 1988;232:26–36.

    PubMed  Google Scholar 

  11. Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82:679–83.

    Article  PubMed  CAS  Google Scholar 

  12. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop 1986;213:20–33.

    PubMed  Google Scholar 

  13. Hopf A. Hüftpfannenverlagerung durch doppelte Beckenosteotomie zur Behandlung der Hüftgelenkdysplasie und Subluxation bei Jugendlichen und Erwachsenen. Z Orthop 1966;101:559–86.

    PubMed  CAS  Google Scholar 

  14. Hussell JG, Mast JW, Murphy SB, Howie DW, Ganz R. A comparison of different surgical approaches for the periacetabular osteotomy. Clin Orthop 1999;363:64–72.

    PubMed  Google Scholar 

  15. Hussell JG, Rodriguez JA, Ganz R. Technical complications of the Bernese periacetabular osteotomy. Clin Orthop 1999;363:81–92.

    PubMed  Google Scholar 

  16. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. J Bone Joint Surg Br 1991;73:423–9.

    PubMed  CAS  Google Scholar 

  17. Lack W, Windhager R, Kutschera HP, Engel A. Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia. J Bone Joint Surg Br 1991;73:229–34.

    PubMed  CAS  Google Scholar 

  18. Langlotz F, Bächler R, Berlemann U, Nolte L-P, Ganz R. Computer assistance for pelvic osteotomies. Clin Orthop 1998;354:92–102.

    Article  PubMed  Google Scholar 

  19. Le Coeur P. Corrections des défauts d’orientation de l’articulation coxofémorale par ostéotomie de l’isthme iliaque. Rev Chir Orthop 1965;51:211–2.

    Google Scholar 

  20. Lequesne M, de Sèze S. Le faux profil du bassin. Nouvelle incidence radiographique pour l’étude de la hanche. Son utilité dans les dysplasies et les différentes coxopathies. Rev Rhum Mal Osteoartic 1961;28:643–52.

    PubMed  CAS  Google Scholar 

  21. Leunig M, Werlen S, Ungersböck A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br 1997;79:230–4.

    Article  PubMed  CAS  Google Scholar 

  22. Love BRT, Stevens PM, Williams PF. A long term review of shelf arthroplasty. J Bone Joint Surg Br 1980;62:321–5.

    PubMed  CAS  Google Scholar 

  23. Matta JM, Stover MD, Siebenrock K. Periactabular osteotomy through the Smith-Petersen approach. Clin Orthop 1999;363:21–32.

    PubMed  Google Scholar 

  24. Mayo KA, Trumble SJ, Mast JW. Results of periacetabular osteotomy in patients with previous surgery for hip dysplasia. Clin Orthop 1999;363:73–80.

    PubMed  Google Scholar 

  25. Millis MB, Murphy S, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. J Bone Joint Surg Am 1995;77:626–47.

    Google Scholar 

  26. Murphy SB, Ganz R, Müller ME. The prognosis of untreated dysplasia of the hip. J Bone Joint Surg Am 1995;77:985–9.

    PubMed  CAS  Google Scholar 

  27. Murphy SB, Kijewski PK, Millis MB, Harless A. Acetabular dysplasia in the adolescent and young adult. Clin Orthop 1990;261:214–23.

    PubMed  Google Scholar 

  28. Murphy SB, Millis MB, Hall JE. Surgical correction of acetabular dysplasia in the adult. Clin Orthop 1999;363:38–44.

    PubMed  Google Scholar 

  29. Myers SR, Eijer H, Ganz R. Anterior femoroacetabular im**ement after periacetabular osteotomy. Clin Orthop 1999;363:93–9.

    PubMed  Google Scholar 

  30. Nakamura S, Ninomiya S, Takatori Y, Morimoto S, Umeyama T. Long-term outcome of rotational acetabular osteotomy. Acta Orthop Scand 1998;69:259–65.

    Article  PubMed  CAS  Google Scholar 

  31. Ninomiya S, Tagawa H. Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am 1984;66:430–6.

    PubMed  CAS  Google Scholar 

  32. Nishio A. Transposition osteotomy of the acetabulum in the treatment of congenital dislocation of the hip. J Jpn Orthop Assoc 1956;30:482–4.

    Google Scholar 

  33. Salter RB. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg Br 1961;43:518–39.

    Google Scholar 

  34. Severin E. Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand 1941;63:Suppl:53–4.

    Google Scholar 

  35. Siebenrock KA, Schöll E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. A minimal follow-up of 10 years. Clin Orthop 1999;363:9–20.

    PubMed  Google Scholar 

  36. Steele HH. Triple osteotomy of the innominate bone. J Bone Joint Surg Am 1973;55:343–50.

    Google Scholar 

  37. Stulberg SD, Harris WH. Acetabular dysplasia and development of osteoarthritis of the hip. In: The hip. Proceedings of the second open scientific meeting of the Hip Society. St. Louis: Mosby, 1975:82.

    Google Scholar 

  38. Sutherland DH, Greenfield R. Double innominate osteotomy. J Bone Joint Surg Am 1977;59:1082–91.

    PubMed  CAS  Google Scholar 

  39. Tönnis D. Eine neue Form der Hüftpfannenschwenkung durch Dreifachosteotomie zur Ermöglichung späterer Hüftprothesenversorgung. Orthop Prax 1979;15:1003–5.

    Google Scholar 

  40. Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin: Springer, 1987.

    Google Scholar 

  41. Tönnis D, Arning A, Bloch M, Heinecke A, Kalchschmidt K. Triple pelvic osteotomy. J Pediatr Orthop B 1994;3:54–67.

    Google Scholar 

  42. Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am 1995;77:73–85.

    PubMed  CAS  Google Scholar 

  43. Trumble SJ, Mayo KA, Mast JW. The periacetabular osteotomy. Clin Orthop 1999;363:54–63.

    PubMed  Google Scholar 

  44. Wagner H. Korrektur der Hüftgelenksdysplasie durch die sphärische Pfannendachplastik. In: Chapchal G, Hrsg. Beckenosteotomie — Pfannendachplastik. Stuttgart: Thieme, 1965:68–9.

    Google Scholar 

  45. Wagner H. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. J Bone Joint Surg Am 1995;77:626–47.

    Google Scholar 

  46. Ward TW, Fleisch I-D, Ganz R. Anatomy of the iliocapsularis muscle. Clin Orthop 2000;374:278–85.

    Article  PubMed  Google Scholar 

  47. Weber M, Ganz R. The anterior approach to hip and pelvis. Orthop Traumatol;2002;10:in press.

  48. Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand 1939;83:Suppl. 58:7–38.

    Google Scholar 

  49. Zeiler G. Chiari pelvic osteotomy in coxarthrosis secondary to acetabular dysplasia. Proceedings of SICOT Congress XVII, Gräfelfing, 1987:235.

Download references

Author information

Authors and Affiliations

  1. University Hospital and Policlinic of Orthopedic Surgery Inselspital, 3010, Bern, Switzerland

    Martin Weber MD & Reinhold Ganz

Authors
  1. Martin Weber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reinhold Ganz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Weber MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weber, M., Ganz, R. The Bernese periacetabular osteotomy. Orthop Traumatol 10, 93–112 (2002). https://doi.org/10.1007/s00065-002-1040-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00065-002-1040-1

Key Words

Search

Navigation