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A New Minimally Invasive Transsartorial Approach for Periacetabular Osteotomy
A. Troelsen, MD1; B. Elmengaard, MD, PhD1; K. Søballe, MD, DMSc1
1 Orthopaedic Research Unit, University Hospital of Aarhus, Buildings 7B (A.T. and B.E.) and 1B (K.S.), Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark. E-mail address for A. Troelsen: a_troelsen@hotmail.com. E-mail address for B. Elmengaard: brianelm@dadlnet.dk. E-mail address for K. Søballe: kjeld@soballe.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (the measuring device used in the study is a commercially available product developed by one of the authors). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.
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Investigation performed at the Orthopaedic Research Unit, University Hospital of Aarhus, Aarhus, Denmark

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Mar 01;90(3):493-498. doi: 10.2106/JBJS.F.01399
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Background: A new minimally invasive transsartorial approach for the Bernese periacetabular osteotomy was developed. We investigated whether this technique was safe and successful with regard to minimizing tissue trauma and, more importantly, whether it was possible to obtain optimal reorientation of the acetabulum.

Methods: Our experience with this approach was retrospectively assessed by means of database inquiry and the evaluation of radiographs. We assessed ninety-four procedures performed between April 2003 and August 2005 to determine perioperative and early postoperative outcome measures, the achieved acetabular reorientation, and hip joint survival.

Results: The mean duration of surgery was 73.1 minutes, the median perioperative blood loss was 250 mL, and the mean reduction in the hemoglobin level was 33 g/L. Blood transfusion was required following 3% of the procedures. No injuries to the great vessels or nerves, arterial thromboses, unintended extension of the osteotomy, or deep infections occurred. The postoperative acetabular reorientation was assessed by measuring the center-edge and acetabular index angles, the medians of which were 34° and 3°, respectively. With total hip arthroplasty as the end point, the hip joint survival rate was estimated to be 98% at 4.3 years.

Conclusions: Osteotomy with use of this minimally invasive transsartorial approach appears to be a safe, relatively short surgical procedure associated with a relatively small amount of blood loss and minimal transfusion requirements. Optimal acetabular reorientation can be achieved with this technique.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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