Background: Most reports on the results of the Bernese
periacetabular osteotomy for the treatment of developmental dysplasia of the
hip have been by the originators of the procedure. In 1997, we began to use
this osteotomy without direct training from the originators of the
Methods: Seventy-three patients (eighty-three hips) underwent a
Bernese periacetabular osteotomy between 1997 and 2003 and were followed
prospectively with use of the Harris hip score to assess clinical results and
with use of anteroposterior pelvic and false-profile lateral plain radiographs
to assess radiographic results. The three-dimensional position of the
acetabulum was recorded preoperatively and postoperatively. The mean duration
of follow-up was forty-six months.
Results: The average Harris hip score improved from 54 to 87 points
(p < 0.001). Three hips (three patients) had a conversion to total hip
arthroplasty at two, three, and four years after the periacetabular osteotomy.
Preoperatively, fifty-four of the eighty-three acetabula were anteverted, and
twenty-nine were either retroverted or had neutral wall relationships.
Postoperatively, sixty-five hips (78%) were anteverted. Radiographically, in
preoperatively anteverted hips, the average center-edge angle improved from
3° to 29° (p < 0.0001), the average anterior center-edge angle
improved from 5° to 31° (p < 0.0001), and the acetabular index
improved from 25° to 5° (p < 0.0001). In preoperatively retroverted
or neutral hips, the average center-edge angle improved from 13° to
33° (p < 0.0001), the average anterior center-edge angle improved from
15° to 36° (p < 0.0001), and the acetabular index improved from
19° to 2° (p < 0.0001). Complications included four hematomas,
three transient femoral nerve palsies, two deep wound infections, and one
transient sciatic nerve palsy. Nine of the ten major complications and all
four of the failed osteotomies occurred in the first thirty hips in which the
index procedure was performed.
Conclusions: In our experience, the early results of the Bernese
periacetabular osteotomy have been encouraging, with a 92% survival rate at
thirty-six months. The occurrence of complications demonstrates a substantial
learning curve. Recognition of the true preoperative acetabular version and
reorientation of the acetabulum into an appropriately anteverted position have
become important factors in surgical decision-making.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.