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Complications Associated with the Bernese Periacetabular Osteotomy for Hip Dysplasia in Adolescents

¹ Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for D.J. Sucato: dan.sucato{at}tsrh.org

Investigation performed at the Texas Scottish Rite Hospital for Children, Dallas, Texas

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Methods A retrospective clinical and radiographic review of a consecutive series of adolescent patients who underwent a Bernese periacetabular osteotomy for hip dysplasia was conducted.

Results Eighty-three osteotomies were performed in seventy-six patients with an average age (and standard deviation) of 15.6 ± 2.4 years. Significant improvement from the preoperative to the two-year follow-up evaluation was seen radiographically with regard to the lateral center-edge angle (–0.14° to 35.5°), the ventral center-edge angle (–5.13° to 31.3°), and the femoral head extrusion index (38.4% to 7.7%) (p < 0.0001 for all). There were three major complications, including excessive arterial bleeding requiring embolization in a patient with a prior acetabuloplasty, osteonecrosis of the acetabular fragment in a patient with severe dysplasia and subluxation of the hip, and osteonecrosis of the femoral head following combined periacetabular and femoral osteotomies in a patient with Charcot-Marie-Tooth disease. Eighteen hips (22%) had minor complications, including nonunion of the superior pubic ramus osteotomy (five hips), a superficial stitch abscess (four), and transient lateral femoral cutaneous nerve palsy (four). Nine hips (11%) underwent removal of symptomatic screws, and two required a second operation to reposition the acetabular fragment. An underlying diagnosis other than developmental dysplasia increased the prevalence of minor complications (p = 0.0017), while a major complication was more likely with longer surgery time, greater blood loss, and proximal femoral osteotomy.

Conclusions The Bernese periacetabular osteotomy is a joint-preserving procedure that very effectively corrects acetabular dysplasia in adolescent patients, providing improved radiographic results and a low rate of complications. Although the rate of minor complications is increased when there is an underlying diagnosis other than developmental dysplasia, no other predictors were identified. However, a major complication is more likely with a longer duration of surgery and with a concomitant femoral varus osteotomy.

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

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