The Bernese periacetabular osteotomy (PAO) has become a widely used procedure for hip preservation in adolescent and young adult patients with symptomatic anatomic aberrancies of the acetabulum due to developmental hip dysplasia, trauma, infection, femoroacetabular impingement, and other causes.1-6 Acetabular dysplasia is one of the most common causes of secondary osteoarthritis, and the goal of PAO is to slow or halt the progression of arthrosis to prolong or potentially eliminate the need for total hip arthroplasty while relieving pain and increasing function and activity.1,7,8
The PAO involves realigning the acetabulum to improve anterior and lateral coverage of the femoral head, acetabular anteversion, and medicalization of the joint.5,6 It is preferred over other described acetabular osteotomies due to its inherent stability given that the posterior column is not violated.3,5,6,9 Since its initial description in 1988,5 short-, medium- and long-term outcomes have been reported with excellent patient satisfaction and function.2,7,10-15 The radiographic, functional, and patient satisfaction outcomes are excellent; therefore, this has become an accepted form of treatment for acetabular dysplasia.16 Additional procedures, such as hip arthroscopy, have also been combined with PAO to treat intra-articular pathologies without open arthrotomy.17 Several studies have evaluated preoperative radiographic factors, such as Tönnis grade, previous surgeries, and morphology of the hip; as well as demographic factors, such as age, body mass index (BMI), comorbid diseases, and activity level, which seem to play a role in the final outcome.11,18,19 This work has advanced our understanding and allowed surgeons to apply selection criteria to improve patient outcomes.
There are multiple reported complications of the PAO procedure, including infection,2 wound dehiscence,20 periacetabular fracture,21 intra-articular extension of the osteotomy,22 excessive acetabular retroversion,23,24 hardware failure, femoral or sciatic nerve palsy,25 heterotopic ossification, prominent hardware, deep vein thrombosis or pulmonary embolism,26 osteonecrosis of the femoral head or acetabulum,24 non-union,24 intrapelvic bleeding,24 incisional hernia,27 lateral femoral cutaneous nerve palsy,20,28 and reflex sympathetic dystrophy.1,2,29 There are also several studies reporting a learning curve phenomenon, in which the proportion of complications is higher in the initial series of surgeries performed by each specific surgeon.22,20,29
Despite the widely reported short-, medium-, and long-term results of this treatment, no study thus far has attempted to correlate preoperative patient factors with early perioperative outcomes and complications. This information would be useful in patient counseling and decision making in the early postoperative period. Therefore, the purpose of this study is to analyze data from the perioperative period in patients who have undergone the PAO performed by a single surgeon at our institution to determine any correlation between patient characteristics such as age, comorbid disease, hip pathologic diagnosis, BMI, or previous procedures and perioperative complications occurring within the first 90 days.
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