Bernese Periacetabular Osteotomy: Technical Aspects and Clinical Results

Abstract

The Bernese periacetabular osteotomy is a joint preserving procedure used in young adults to improve acetabular coverage and stabilize the femoral head. This juxta-articular osteotomy respects the vascular blood supply to the acetabular fragment. It facilitates extensive acetabular reorientation and can be combined with a femoral osteotomy. All acetabular osteotomy steps are performed using the modified Smith-Petersen approach. Anterior joint inspection provides information on acetabular rim pathology and allows control of an impingement free range of motion. The posterior column remains mechanically intact allowing minimal internal fixation and early mobilisation. The dimensions of the true pelvis remain unchanged permitting vaginal delivery. Over 700 pelvic osteotomies have been performed since the introduction of the Bernese periacetabular osteotomy. A greater than 10 year follow-up of the first 75 osteotomies revealed hip joint preservation in 82% of cases with a good to excellent result in 73%. Poor results correlated with increased age, pre-existing arthritis, labral pathology and the amount of correction. Treatment of the labral lesions was performed only if unstable and included either refixation or resection.