The Periacetabular Osteotomy Technique

Adult development dysplasia of the hip is characterized predominantly by deficient anterior and lateral femoral head coverage. Numerous pelvic and femoral osteotomies have been developed to help restore proper joint biomechanics and delay the onset of osteoarthritis. Reinhold Ganz developed the Bernese periacetabular osteotomy in 1984 to address acetabular dysplasia. The Ganz osteotomy 3-dimensionally reorients the acetabulum so that hip joint forces are more evenly distributed. Since then, the procedure has evolved slightly in the surgical approach and technique, but the fundamental osteotomies remain the same. The learning curve for the technique remains steep with potentially high complication rates and long operative times. The senior author has been performing this procedure since 1987 with nearly 500 procedures performed. Initial operative times for the senior author averaged similar to 3 hours and have decreased to similar to 60 to 75 minutes. This manuscript will demonstrate the senior author's surgical technique of the periacetabular osteotomy as it has evolved over nearly 30 years. The authors hope that this technique description can facilitate other surgeons' progress on the learning curve for this technically difficult but beneficial technique.