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

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is there a place for borderline periacetabular osteotom y
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Is there a Place for Borderline Periacetabular Osteotom y Javad - - PowerPoint PPT Presentation

Oct 10, 2023 166 likes •515 views

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

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Is there a Place for Borderline Periacetabular Osteotom y

Javad Parvizi MD FRCS Professor of Orthopaedic Surgery

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 Research support:

 NIH  OREF  DOD  Aircast  AOA  MTF  Stryker Orthopaedics  The Knee Society  Baxter  3M  Zim m er  Biom em etics  Wyeth  Canadian Health

Consultant:

Stryker Orthopaedics

Zim m er

Biom et

Sm ith and Nephew

Convatech

Covidien

TissueGene

Ceram tec

OsteoMEM

Intellectual Property/ Royalty:

Sm arTech

Elsevier

Wolters Kluwer

Slack

Disclosures

Board Member/ Adviser

CD Diagnostics

Philadelphia Orthopaedic Soc

Eastern Orthopedic Assoc.

United Healthcare

Magnifi Group (Publishers)

3M

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PAO for DDH

Is there a place for

PAO in borderline DDH?

Yes

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PAO for DDH

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

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Norm al Hip

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Norm al Hip

Structure of hip:

Casper et al Noble et al

 Race  Age Gender Genetics

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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.

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 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

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DDH

Pathology  Pattern of abnormalities

 Acetabulum

Shallow, lateralized,

anteverted

Deficient anteriorly, superiorly

 Femoral Head

Small head Short neck Excessive anteversion Coxa valga

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PAO for DDH

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

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Radiographic Assessment

10 degrees 32 degrees

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Center Edge Angle

5 degrees 22 degrees

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Anterior Coverage

No anterior coverage on right

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Subluxation

Minimal cephalad subluxation

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17 mm

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DDH

Borderline

CEA <15 (20) Tonnis >15 (20)

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DDH

Types

AnterolateralAnterior Lateral Posterolateral

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DDH

Biom echanics

 Causes instability  Increased stress on

acetabular rim

 Labral hypertrophy  Labral tear  OA

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7 mm 2 mm 11 mm 22.5 mm

Preoperative 14 months after Hip Scope

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PAO for DDH

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

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SLIDE 23 Rothman Institute of Orthopaedics at Thomas Jefferson University
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SLIDE 24 Rothman Institute of Orthopaedics at Thomas Jefferson University
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SLIDE 25 Rothman Institute of Orthopaedics at Thomas Jefferson University
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PAO

Outcome

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

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PAO

Outcome

2002 2003 2005

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PAO for DDH

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

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PAO vs Arthroscopy

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PAO vs Arthroscopy

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