Comparison of the minimally invasive and ilioinguinal approaches for periacetabular osteotomy 263 single-surgeon procedures in well-defined study groups

Background and purpose Periacetabular osteotomy is the treatment of choice in young adults with hip dysplasia. Patient morbidity and surgical outcome may depend on the choice of surgical approach. We compared the outcome of a new minimally invasive approach to that of the frequently used “classic” ilioinguinal approach.

Patients and methods We retrospectively evaluated our experience with the ilioinguinal and minimally invasive approaches, which were used in successive time periods at our institution between December 1998 and February 2007 (n=263). Intraoperative and early postoperative outcome factors together with analysis of hip joint survival were compared in well-defined study groups.

Results In the minimally invasive and ilioinguinal groups respectively, the median (interquartile range) intraoperative blood loss was 250 (200–350) mL and 500 (350–700) mL (p<0.001), the mean (95% CI) hemoglobin reduction was 2.0 (1.9–2.1) mmol/L and 2.5 (2.4–2.7) mmol/L (p<0.001), transfusion was required following 4% and 18% of the procedures (p<0.001), and the median (interquartile range) duration of surgery was 70 (60–75) min and 100 (80–120) min (p<0.001). Median (interquartile range) postoperative center-edge and acetabular index angles were 33˚ (30–36) and 2˚ (0–6), respectively, in the minimally invasive group and 31˚ (25–35) and 9˚ (1–14) in the ilioinguinal group. There were no cases of moderate or severe complications in the minimally invasive group and 3 cases of arterial thrombosis in the ilioinguinal group (3%). At follow-up of 5 years, the hip joint survival rates were 97% in the minimally invasive group and 93% in the ilioinguinal group.

Interpretation Given the accumulated experience of the surgeon, the outcome of the minimally invasive approach compares favorably with that of the ilioinguinal approach, and the results support continued use of the minimally invasive approach for periacetabular osteotomy. Using this approach, we did not encounter any complications and acetabular reorientation was not compromized.