One-stage Combined Hip Arthroscopy and Periacetabular Osteotomy.

Abstract

Intra-articular hip pathology is common in young patients with hip dysplasia. One-stage combined hip arthroscopy and periacetabular osteotomy (PAO) allows for thorough treatment of both intra-articular pathology (labral tear and cartilage defects) and a dysplastic acetabulum in a single surgical setting. We describe our method for efficiently and effectively accomplishing both procedures in pediatric and adolescent patients, with emphasis on a streamlined set-up and transition.

Key concepts: (1)One-stage combined hip arthroscopy and periacetabular osteotomy (PAO) addresses all relevant hip pathologies in a single, same-day surgery and facilitates patient recovery through one postoperative rehabilitation program.(2)A specialized surgical table attachment system and a dedicated, experienced surgical team optimize efficiency during the transition between the two procedures and minimize the need to move the patient to a second operating room (OR) table.(3)Hip arthroscopy may be performed using limited arthrotomy, and the capsule may not need to be closed. To enhance efficiency, hip joint capsule management can be deferred to the PAO portion, either for plication of the capsule or, in rare cases, for additional work on femoroplasty after correcting acetabular coverage.(4)Before concluding the PAO procedure, it can be helpful to use a "checklist" to confirm that the acetabulum has been appropriately corrected.