PeriAcetabular PeriAcetabular OsteotomyOsteotomy
28 y/o lady with severe left hip pain.28 y/o lady with severe left hip pain. Pain for 6 years, no clicking in hip.Pain for 6 years, no clicking in hip. Unable to exercise due to pain.Unable to exercise due to pain. On PE, positive Stinchfield and FADIR On PE, positive Stinchfield and FADIR
tests.tests. On PE, hip flexion at 90 degrees with On PE, hip flexion at 90 degrees with
IR of 10 degrees., Right hip IR is 25 IR of 10 degrees., Right hip IR is 25 degrees.degrees.
Pre-Op x-raysPre-Op x-rays
CEA= 28 degrees
Pre-opPre-op
Abduction and Internal Rotation
False Profile left Hip
11stst Osteotomy Osteotomy
Anterior Anterior IschiumIschium
PAO
22ndnd Osteotomy Osteotomy
PubisPubis
33rdrd Osteotomy Osteotomy
Anterior Ilium to Anterior Ilium to 1 cm from pelvic 1 cm from pelvic
BrimBrim
Osteotomy #3
Osteotomy #4Osteotomy #4Intrapelvic from Ilium Intrapelvic from Ilium towards Ischial spine towards Ischial spine
parallel to greater sciatic parallel to greater sciatic notchnotch
Osteotomy #5Osteotomy #5Complete Ischial Complete Ischial
osteotomy from intra-osteotomy from intra-pelvic area and anterior to pelvic area and anterior to
posterior column.posterior column.
Mobilizing the Mobilizing the FragmentFragment
PAO
PAO
PAO
PAO
PAO
Fragment in final Fragment in final PositionPosition
No crossover SignNo crossover Sign
PAO
Fixation from anterior ilium Fixation from anterior ilium to posterior column with a to posterior column with a
3.5 mm cortical bone screw3.5 mm cortical bone screw
PAO
PAO
Final FixationFinal Fixation2 more 3.5 cortical 2 more 3.5 cortical
bone screws from iliac bone screws from iliac crest into fragment!!crest into fragment!!
PAO
PAO
PAO
CEA 28 degrees
CEA 43 degrees
PAOPAO