The Bernese periacetabular osteotomy

A dysplastic acetabulum inadequately covering the femoral head is freed from the bony pelvis through several osteotomy cuts close to the joint, properly positioned and fixed with three screws. Symptomatic acetabular dysplasia with closed physes. Osteoarthritis Tönnis stage ≤2. Improved coverage on abduction view. Dislocation. Neoacetabulum. Worsening of congruence in abduction. Osteoarthritis Tönnis stage 3. Modified Smith-Petersen approach. Incomplete osteotomy of the ischial ramus. Complete osteotomy of the pubic ramus. Supra- and retroacetabular osteotomies: perpendicular osteotomy directly below the anterosuperior iliac spine ending short of the linea terminalis, continuing in direction of the ischial spine. Osteotomy 4 cm below the linea terminalis, connecting to the ischial osteotomy. Mobilization and reorientation. Radiographic control. Anterior capsulotomy: check for labral and chondral pathology, and impingement. Fixation with three 3.5-mm cortical screws. Reconstruction of the detached structures. No cast or orthosis. Touch weight bearing for 8 weeks, then abductor strengthening. Of the first 63 patients, 60 (71 hips) were followed for 10–14 years. 58 hip joints were still preserved (82%), and function was excellent to good in 52 (73%). Negative prognostic factors were advanced age, osteoarthritis, and insufficient correction.