Bernese Periacetabular Osteotomy: A Comparative Study of Four Types of Incisions.

Bernese periacetabular osteotomy has diverse complications associated with incisions, such as dehiscence, hypertrophy, depression, and hyperpigmentation on scars, which affect patient satisfaction. The objective was to evaluate aesthetics and satisfaction outcomes in four different incisions. We evaluated 176 incisions in 148 patients. The incisions performed were the original modified (16, group I), straight and shortened, (64, group II), "Z" shaped (16, group III), and oblique inguinal (48, group IV). The scars were evaluated for width and length, development of a hypertrophic scar, depression or hyperpigmentation, and dehiscence and resuture. A scale of satisfaction was applied (points ranging from 1 to 10). The Bartlett test and Kruskal-Wallis test were used. The mean width and length of the scars were 20.3 and 6.8 cm for group I, 6.5 and 8.1 for group II, 12.1 and 7.1 cm for group III, 13 and 1.4 cm for group IV, respectively. Hypertrophic scars were found in 18% in group I, 12.5% in group II, and 31.2% in group III. Depressed scars were found in 10.8% in group I and 7.1% in group II. Hyperpigmentation was found in 16% in groups I and II, 37% in group III, and 2% in group IV. Dehiscence was found in 8.1% in group I and 8.9% in group II. Satisfaction for group IV was nine points. The difference in length and width and satisfaction were statistically significant (P < 0.05). The oblique inguinal incision (group IV) showed a smaller percentage of complications, with an adequate aesthetic result, and a high grade of patient's satisfaction.

Bernese periacetabular osteotomy: functional outcomes in patients with untreated intra-articular lesions.

Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19-31), 96% females. Mean follow-up 7 years (range: 3-16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.