Is there a Place for Borderline Periacetabular Osteotom y Javad - PowerPoint PPT Presentation

Is there a Place for Borderline Periacetabular Osteotom y Javad Parvizi MD FRCS Professor of Orthopaedic Surgery

Disclosures Consultant:   Research support : Stryker Orthopaedics   NIH Zim m er  Biom et   OREF Sm ith and Nephew   DOD Convatech   Aircast Covidien   AOA TissueGene  Ceram tec   MTF OsteoMEM   Stryker Orthopaedics Intellectual Property/ Royalty:   The Knee Society Sm arTech   Baxter Elsevier   3M Wolters Kluwer  Slack   Zim m er  Biom em etics Board Member/ Adviser   Wyeth CD Diagnostics  Philadelphia Orthopaedic Soc  Canadian Health  Eastern Orthopedic Assoc.   United Healthcare Magnifi Group (Publishers)  3M 

PAO for DDH  Is there a place for PAO in borderline DDH? Yes

PAO for DDH  Borderline?  Nature of PAO  Expectation  Pain relief  Saving the joint  So on

Norm al Hip

Norm al Hip  Structure of hip: Casper et al Noble et al  Race  Age  Gender  Genetics

Genetic Linkage of Canine Hip Dysplasia  Complex quantitative (multifactorial) trait inheritance pattern  Extensive studies based on multi-generation pedigrees  Candidate gene screening is ongoing Todhunter RJ J Hered 2003.

 4 Mb region on chromosome 17q21 (CORR 2009)  Variable Expression of gene (J Arthroplasty 2012)  DDH Linkage to CX3CR1 in a large family (JBMR 2013)  Coexpression with Tenurin-3 results in severe disease

DDH Pathology  Pattern of abnormalities  Acetabulum  Shallow, lateralized, anteverted  Deficient anteriorly, superiorly  Femoral Head  Small head  Short neck  Excessive anteversion  Coxa valga

PAO for DDH  Borderline?  Nature of PAO  Expectation  Pain relief  Saving the joint  So on

Radiographic Assessment 32 degrees 10 degrees

Center Edge Angle 5 degrees 22 degrees

Anterior Coverage No anterior coverage on right

Subluxation Minimal cephalad subluxation

17 mm

DDH Borderline  CEA <15 (20)  Tonnis >15 (20)

DDH Types Posterolateral Lateral AnterolateralAnterior

DDH Biom echanics  Causes instability  Increased stress on acetabular rim  Labral hypertrophy  Labral tear  OA

7 mm 2 mm 22.5 mm 11 mm Preoperative 14 months after Hip Scope

PAO for DDH  Borderline?  Nature of PAO  Expectation  Pain relief  Saving the joint  So on

Rothman Institute of Orthopaedics at Thomas Jefferson University

Rothman Institute of Orthopaedics at Thomas Jefferson University

Rothman Institute of Orthopaedics at Thomas Jefferson University

PAO Outcome  Proficiency in correction  Labral pathology  Restores function  Relieves pain

PAO Outcome 2005 2003 2002

PAO for DDH  Borderline?  Nature of PAO  Expectation  Pain relief  Saving the joint  So on

PAO vs Arthroscopy

PAO vs Arthroscopy