PeriAcetabular PeriAcetabular OsteotomyOsteotomy

28 y/o lady with severe left hip pain.28 y/o lady with severe left hip pain. Pain for 6 years, no clicking in hip.Pain for 6 years, no clicking in hip. Unable to exercise due to pain.Unable to exercise due to pain. On PE, positive Stinchfield and FADIR On PE, positive Stinchfield and FADIR

tests.tests. On PE, hip flexion at 90 degrees with On PE, hip flexion at 90 degrees with

IR of 10 degrees., Right hip IR is 25 IR of 10 degrees., Right hip IR is 25 degrees.degrees.

Pre-Op x-raysPre-Op x-rays

CEA= 28 degrees

Pre-opPre-op

Abduction and Internal Rotation

False Profile left Hip

11stst Osteotomy Osteotomy

Anterior Anterior IschiumIschium

PAO

22ndnd Osteotomy Osteotomy

PubisPubis

33rdrd Osteotomy Osteotomy

Anterior Ilium to Anterior Ilium to 1 cm from pelvic 1 cm from pelvic

BrimBrim

Osteotomy #3

Osteotomy #4Osteotomy #4Intrapelvic from Ilium Intrapelvic from Ilium towards Ischial spine towards Ischial spine

parallel to greater sciatic parallel to greater sciatic notchnotch

Osteotomy #5Osteotomy #5Complete Ischial Complete Ischial

osteotomy from intra-osteotomy from intra-pelvic area and anterior to pelvic area and anterior to

posterior column.posterior column.

Mobilizing the Mobilizing the FragmentFragment

PAO

PAO

PAO

PAO

PAO

Fragment in final Fragment in final PositionPosition

No crossover SignNo crossover Sign

PAO

Fixation from anterior ilium Fixation from anterior ilium to posterior column with a to posterior column with a

3.5 mm cortical bone screw3.5 mm cortical bone screw

PAO

PAO

Final FixationFinal Fixation2 more 3.5 cortical 2 more 3.5 cortical

bone screws from iliac bone screws from iliac crest into fragment!!crest into fragment!!

PAO

PAO

PAO

CEA 28 degrees

CEA 43 degrees

PAOPAO