Single Table Concomitant Post‐Less Hip Arthroscopy Combined with Periacetabular Osteotomy for Hip Dysplasia

Figures

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  Fig 1. View of standard Hana table setup with Pink Hip Kit and patient draw sheet folded in half from the (A) side and (B) above. (C) View from above of the ideal patient placement with perineum approximately 4 to 6 cm from the post positioning hole.

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  Fig 2. (A) Patient is supine with the left hip sterilely prepped and draped and inferior margin of iliac crest outlined. The ASIS and GT are marked as well. The incision of the periacetabular osteotomy is made from the GT and is connected to the MAP. (B) Incision for the PAO is made from the GT to the MAP. (C) Exposure of the EOF is important before masking. (D) Fleck osteotomy of the ASIS off of the IC using a one-half-inch straight osteotome. (AL, anterolateral portal; ASIS, anterosuperior iliac spine; DALA, distal anterolateral accessory portal; EOF, external abdominal oblique muscle and fascia; GT, gluteal tubercle; IC, iliac crest; MAP, mid-anterior portal; PAO, periacetabular osteotomy.)

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  Fig 3. Magnetic resonance imaging based 3-dimensional rendering of a left hip joint viewed anteriorly is used for preoperative planning. This demonstrates typical findings of focal femoroacetabular impingement found in the dysplastic hip with a minimal cam and pincer (*), which are labeled. (PS, pubic symphysis; SS, subspine.)

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  Fig 4. Intraoperative fluoroscopic images of a left hip periacetabular osteotomy. (A) Anteroposterior view demonstrating the narrow curved osteotome against the medial aspect of the anterior ischium prior to osteotomy. (B) Iliac oblique view with the acetabulum outlined in blue and posterior column including ischial spine outlined in green showing the (C) appropriate depth of the curved osteotome of the incomplete ischial osteotomy. (D) Anteroposterior view showing the curved osteotome’s ideal position behind the acetabulum.

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  Fig 5. Fluoroscopic images of the left hip. (A) Wide straight osteotome in correct position on the anteroposterior view overlying the acetabular teardrop. (B) Iliac oblique view with the iliac osteotomy made using the oscillating saw outlined in blue. (C) Iliac oblique view of the straight osteotome coming behind the acetabulum and (D) connecting with the previous incomplete ischial osteotomy, which is outlined in blue.

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  Fig 6. Left hip fluoroscopic iliac oblique views of the acetabular fragment (A) before correction with the acetabulum outlined in blue and (B) postcorrection with provisional fixation using 3.2-mm drill bits. (C) Iliac oblique and (D) anteroposterior fluoroscopic views showing final position of acetabular fragment following periacetabular osteotomy with 4.5-mm screws in place.

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  Fig 7. Anteroposterior views of the pelvis showing the left hip (A) preoperatively and (B) postoperatively. Increased lateral coverage of the femoral head and decreased inclination of the acetabular sourcil are noted.