The Ganz of periacetabular osteotomy are performed in children, adolescents, and young adults, in which all the pelvic growth plates have finished growing and have closed. The technique involves exposure of the pelvic bone through a groin incision. Once the muscles are retracted, the illian bone is exposed. In the Ganz osteotomy, five bone cuts are made in the pelvic bone, around the acetabular hip socket, and then the socket is rotated within the pelvic bone into a position that is more stable with horizontal coverage on top of the femur. After the position has been corrected, three to four screws are placed to fix the acetabular piece within the pelvis. Once the bone is healed, a new socket should allow for better coverage of the hip and reduce further damage to the cartilage and labrum.
Periacetabular osteotomy carries many risks, most notably the risk of nerve injury as the sciatic nerve, pudendal nerve, obturator nerve, and femoral nerve are all in close proximity of the area of the operation. It is extremely rare for these nerves to be severed, but in some cases can be stretched causing injury resulting in weakness and numbness. This often is temporary, but in some rare cases can be permanent.
- Wound Issues: Because the incision is within the groin, sometimes this area can take longer to heal and is prone to injection. If this happens, it is usually a short term complication treated with antibiotics.
- Inadequate or loss of corrections: If a chance of fall were to occur, the socket could come loose from its fixation from the screws, thus requiring revision from the correction. Hardware pain is very common for the screws to be painful, as they are right over the area where the belt and pants occur. I recommend removal for these screws at six months once the acetabular socket is healed. This is a short outpatient procedure.
- Osteoarthritis: It is possible that the progression of osteoarthritis may have already occurred prior to the intervention of the dysplasia. If this has occurred, likely osteoarthritis will continue. It will be at a slower pace, thus may result in the need for a total hip replacement at some point in the patient’s life.
A well performed periacetabular osteotomy should last more than ten years. In many cases, when the procedure is done prior to developing any cartilage damage, more than 80 percent of these cases are still without the need of a hip replacement at 15 years.
Recovery after periacetabular osteotomy does require a period of recovery at home. Patients will often refrain from going to school or work. They will need to use crutches for up to 6-8 weeks and then work on using crutches to restore their gait pattern. Patients are to refrain from sporting activities for at least 6 months and in some cases up to a year.
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Dr. Scott Faucett
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