Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities

Adam I Edelstein; Stephen T Duncan; Sean Akers; Gail Pashos; Perry L Schoenecker; John C Clohisy

doi:10.1093/jhps/hnz014

Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities

J Hip Preserv Surg. 2019 Mar 30;6(2):117-123. doi: 10.1093/jhps/hnz014. eCollection 2019 Jul.

Authors

Adam I Edelstein¹, Stephen T Duncan², Sean Akers³, Gail Pashos³, Perry L Schoenecker⁴, John C Clohisy³

Affiliations

¹ Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI, USA.
² Department of Orthopaedic Surgery, University of Kentucky HealthCare, 125 E. Maxwell St., Suite 201, Lexington, KY, USA.
³ Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO, USA.
⁴ Department of Orthopaedic Surgery, Shriner's Hospital for Children, St. Louis, 4400 Clayton Ave., St. Louis, MO, USA.

Abstract

Surgical hip dislocation (SD) and periacetabular osteotomy (PAO) are well-described treatments for femoroacetabular impingement (FAI) and acetabular dysplasia, respectively. Occasionally, complex deformities require a combined SD/PAO; the morbidity of performing both procedures in a single stage has not been fully investigated. We performed a retrospective review of a consecutive group of patients undergoing combined SD/PAO to investigate the incidence and character of perioperative complications. Forty-five patients (46 hips) were identified. Perioperative complications were graded by the modified Clindo-Davien complication scheme. Mean follow-up was 36 months (range 12-128), and no patients were lost to follow-up. Six complications occurred in six hips (13%). Four (8.7%) complications were minor (Grades I or II): one Brooker Grade III heterotopic ossification requiring no treatment, one superior pubic ramus nonunion requiring no treatment and two superficial wound infections requiring antibiotics. Two (4.3%) complications were major (Grades III or IV): one coxa saltans interna and labral tear requiring hip arthroscopy with labral repair and iliopsoas lengthening, and one deep surgical site infection requiring irrigation and debridement followed by development of arthritis requiring conversion to arthroplasty. The average Harris hip score improved from 62 ± 13 preoperatively to 80 ± 19 at final follow-up. Except for the single joint replacement, there were no long-term disabilities. There were no major neurovascular injuries, osteonecrosis, fractures or trochanteric nonunions. Combined SD/PAO for the treatment of complex, concomitant deformities of the proximal femur and acetabulum is associated with an acceptable risk of complications. The vast majority of complications that occurred were managed without permanent disability. Level of Evidence: IV.