CORRInsights®: Operative Fluoroscopic Correction Is Reliable and Correlates With Postoperative Radiographic Correction in Periacetabular Osteotomy

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Excerpt

Acetabular dysplasia commonly causes secondary arthritis of the hip [2]. Today, the so-called Bernese periacetabular osteotomy (PAO) is one of the most frequently and successfully used joint preserving surgical procedures designed to manage dysplasia in the young active patient [12]. This complex procedure combines a polygonal juxta-articular osteotomy using a modified Smith-Peterson approach. Proper acetabular reorientation can improve long-term survivorship and decelerate the progression of degenerative changes [1]. Overcorrection can produce femoroacetabular impingement, undercorrection may leave a patient with persistent symptoms, and poor congruency of the joint can cause abnormal contact stresses and accelerated chondral damage [4, 9]. Thorough preoperative planning is fundamental in PAO, and is based on plain radiographs and, more importantly, on CT imaging [6]. Clearly, accurate intraoperative imaging is required for implementation of the surgical plan. Fluoroscopy is commonly used for guidance while carrying out this complex osteotomy and for assessment of acetabular fragment reorientation, femoral head coverage, and osteotomy fixation. High-volume surgeons with extensive PAO experience do not necessarily need intraoperative fluoroscopy to check their osteotomy positioning, and prefer plain radiographs for assessment of acetabular reorientation. Intraoperative plain full pelvis radiographs are still considered the best available test under reasonable conditions [2]. However, serial intraoperative radiographs are time-consuming, and therefore, often are replaced by fluoroscopy.
The current study by Wylie and colleagues is a valuable contribution in the quest to test the correlation between plain radiographs and the reliability of fluoroscopy for assessment of femoral head lateral coverage during PAO. This large sample-size study with reproducible methodology is particularly relevant for surgeons with a special interest in joint-preserving surgery of the hip.
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