The Boston experience. Periacetabular osteotomy and anterior arthrotomy via an abductor-sparing surgical approach

To this point, we have only a relatively short term followup in 32 patients with known labral lesions who have been treated by combined periacetabular osteotomy (PAO) and debridement of the damaged anterior labrum. A positive clinical history in association with pain demonstrated with the impingemen t test of flexion-adduction-internal rotation nearly always indicates macro scopic pathology within the anterior portion of the hip joint. Labral lesio ns associated with acetabular dysplasia seem more common with increasing ag e. Labral lesions seem to correlate with arthrosis. We suspect that uncorre cted impinging lesions of the anterior rim have led to some of our early cl inical failures after PAO. We feel that intra-articular treatment of certai n impinging lesions may improve the clinical outcome in these patients. Cor rection of the pathological mechanics in the mature, dysplastic hip certain ly requires restoration of stability by reorienting osteotomy. If intra-art icular derangements of the anterior rim are also present, though, intraarti cular surgery may also be necessary to optimize the outcome. Our early resu lts suggest that the earlier and more complete the correction of the disord ered mechanics in the dysplastic hip, the more complete and longlasting wil l be both relief of clinical symptoms and preservation of a joint free from arthrosis. Anterior arthrotomy to explore the anterior rim, carried out at the time of PAO, employing the direct anterior abductor-sparing approach ( DAA), seems a safe and useful adjunct in treating the mature, dysplastic hi p. Much longer clinical followup and larger treatment groups will be necess ary to allow firm conclusions concerning optimal treatment programs for dif ferent patient subgroups of the adult hip dysplasia syndrome.