The Periacetabular Osteotomy

In hip dysplasia, there is deficiency in the bony acetabular coverage of the femoral head. This can result in increased forces and stress on the acetabular rim complex (labrum and articular cartilage) and result in hip pain and eventual hip osteoarthrosis. The pain may arise from multiple sources such as the overload of the acetabular bone, labrum, capsule, or muscles acting to support the hip. Evaluation of hip dysplasia and instability is done by physical exam and radiographic imaging. Three-dimensional imaging with CT scanning is often necessary as the pattern of acetabular dysplasia is not always the classic anterior lateral deficiency as evaluated by the lateral center-edge angle. The patterns of acetabular deficiency on CT scanning may be anterior only, posterior, or global, even with LCE numbers that are considered “borderline.” The periacetabular osteotomy was developed to reorient the acetabulum to maximize the hyaline cartilage coverage of the femoral head. In the last decade, it has been increasingly utilized as an effective treatment for hip dysplasia and instability. There have been modifications to the approach of the procedure such as sparing the rectus tendon insertion and smaller incisions to decrease the morbidity and recovery from the surgery, and it has been proven to be a safe and effective procedure for patients who have symptomatic hip dysplasia. Procedures such as hip arthroscopy, joint inspection, ostoechondroplasty, surgical dislocation, and femoral osteotomies can be performed concurrently. This chapter describes the indications and technique of the periacetabular osteotomy.