PeriAcetabular Osteotomy

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PeriAcetabular Osteotomy

• 28 y/o lady with severe left hip pain.
• Pain for 6 years, no clicking in hip.
• Unable to exercise due to pain.
• On PE, positive Stinchfield and FADIR tests.
• On PE, hip flexion at 90 degrees with IR of 10
  degrees., Right hip IR is 25 degrees.

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Pre-Op x-rays
CEA 28 degrees
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Pre-op
False Profile left Hip
Abduction and Internal Rotation
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1st Osteotomy

• Anterior Ischium

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PAO
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2nd Osteotomy

• Pubis

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3rd Osteotomy

• Anterior Ilium to 1 cm from pelvic Brim

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Osteotomy 3
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Osteotomy 4

• Intrapelvic from Ilium towards Ischial spine
  parallel to greater sciatic notch

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Osteotomy 5

• Complete Ischial osteotomy from intra-pelvic area
  and anterior to posterior column.

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Mobilizing the Fragment
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PAO
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PAO
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PAO
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PAO
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PAO
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Fragment in final Position

• No crossover Sign

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PAO
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Fixation from anterior ilium to posterior column
with a 3.5 mm cortical bone screw
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PAO
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PAO
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Final Fixation

• 2 more 3.5 cortical bone screws from iliac crest
  into fragment!!

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PAO
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PAO
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PAO
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PAO
PAO
CEA 43 degrees
CEA 28 degrees