Minimizing osteotomy related complications for abductor sparing periacetabular osteotomy using C-arm image intensification.

Abstract

The purpose of this study was to determine if C-arm image intensification reliably prevents violations of the posterior column or the hip joint at periacetabular osteotomy sites independent of pelvic flexion and rotation. To assess osteotome placement at the infracotyloid groove, quadrilateral plate, and inner ischial sites, anteroposterior (AP) and false-profile C-arm image intensification views were obtained at each site during both pelvic flexion (0 degrees, 10 degrees, 20 degrees, and 30 degrees) and rotation (0 degrees, 10 degrees, 20 degrees, and 30 degrees). At the infracotyloid groove, AP and false-profile C-arm image intensification confirmed perpendicular orientation of the bifid osteotome in all degrees of pelvic flexion and rotation. On the false-profile view, pelvic flexion and rotation did not impact C-arm image intensification visualization of the posterosuperior and inferior joint spaces at the quadrilateral plate and inner ischial sites, respectively. Optimal step-off of the osteotome from the posterior column was demonstrated on all false-profile views of the quadrilateral plate. Despite varying degrees of pelvic flexion and rotation, C-arm AP and false-profile views confirm accurate osteotome placement, as well as violations of the posterior column or the hip joint at the infracotyloid groove, quadrilateral plate, and inner ischial osteotomy sites. C-arm image intensification is a reliable tool in preventing posterior column violation and an intra-articular osteotomy during an abductor sparing periacetabular osteotomy.