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Original Article
Periacetabular osteotomy for hip dysplasia treatment through a mini-invasive technique. Our results at mid-term in 131 cases
Osteotomía periacetabular en el tratamiento de displasia de cadera mediante técnica mini-invasiva. Nuestros resultados a medio plazo en 131 casos
L. Ramírez-Núñeza,
Corresponding author
luis.ramirez@icatme.com

Corresponding author.
, J. Payo-Ollerob, M. Comasa, C. Cárdenasa, V. Bellottia, E. Astaritaa, G. Chacón-Cascioa, M. Ribasa
a Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, Spain
b Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Residual and developmental dysplasia of the hip&#44; known in the English-speaking literature as developmental dysplasia of the hip &#40;DDH&#41;&#44; consists of a series of anatomical abnormalities&#44; the most notable of which is insufficient acetabular coverage&#44; resulting in abnormal load distribution&#46; Consequently&#44; there is an increase in contact pressure at the level of the articular cartilage and joint instability&#44; predisposing to damage to the chondrolabral complex&#44; periarticular structures and possible coxarthrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of hip preservation surgery is to fundamentally correct the anatomical abnormalities and chondrolabral damage that lead to early joint degeneration&#44; with the intention of preventing or delaying the onset of secondary osteoarthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> Therefore&#44; in the absence of articular cartilage degeneration&#44; young patients &#40;15&#8211;40 years of age&#41;&#44; who are active and with these symptomatic anatomical changes are candidates for surgical treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Periacetabular osteotomy &#40;PAO&#41;&#44; the Ganz osteotomy&#44; also known as the Bernese osteotomy&#44; has been gradually gaining in acceptance in recent decades&#44; and is now the gold-standard in skeletally mature patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">PAO consists of an osteotomy around the acetabulum&#44; with a polygonal cut&#44; which enables its reorientation&#44; allowing the following&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Balanced distribution of the loads on the femoral head&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Better acetabular coverage in all planes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Maintenance of contact of the acetabular hyaline cartilage with the femoral head&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">Ganz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> described this technique in 1988 through a modified Smith-Petersen approach with disinsertion&#47;reinsertion of the anterosuperior iliac spine and anterior rectus muscles&#44; thus correctly exposing the acetabulum&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In 2008 the Aarhus school &#40;Prof&#46; S&#248;balle&#59; Troelsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a>&#41; described a mini-invasive modification of the classical POA technique&#44; based primarily on a change in the surgical approach&#46; This approach consists of a trans-sartorial inguinal approach&#44; and has several benefits over the classic technique&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> including a clear reduction in surgical time&#44; directly in relation to the learning curve&#44; but with less blood loss and reduced transfusion requirements&#44; less postoperative pain&#44; rapid functional recovery and aesthetic benefits&#44; since the incision is made in the same direction as the Langer&#39;s lines&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition to benefits inherent to the different types of approach&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;9</span></a> the relevance of the clinical-functional results of these patients is also of note&#46; Short-medium term clinical follow-up shows symptom relief and functional improvement in 40&#37;&#8211;97&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;11</span></a> In addition&#44; up to 71&#37; have been described a return to sports activities&#44; similar or even more intense after the PAO&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#8211;14</span></a> Clinical improvement in relation to pain is of note in this group of patients&#44; and resumption of sports activities at preoperative levels is not compromised&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The study objectives are&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Description of our initial series of patients treated for DDH by mini-invasive PAO&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Description of our patients&#8217; functional results&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall">To enumerate the technical advice of the procedure&#44; based on our experience&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Description of the complications&#44; with the learning curve completed&#44; related with this procedure&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0080" class="elsevierStylePara elsevierViewall">We conducted a retrospective study of patients operated at our centre using a mini-invasive approach&#44; described by Troelsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> over a period of 9 years from 2007 to December 2016&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Patients were included in the study if they had persistent mechanical hip pain&#44; hip dysplasia&#44; congruent joint interline&#44; joint space greater than 3<span class="elsevierStyleHsp" style=""></span>mm&#44; hip flexion greater than 110 and internal hip rotation less than 15&#176;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Of a total of 145 PAO with a minimally invasive approach performed in the period indicated&#44; 3 were excluded because the radiological parameters were not included in our digital radiological system&#44; 4 due to a lack of both digital and functional radiological parameters&#44; and 7 because they were not fully monitored&#46; Consequently&#44; 131 cases were included in 118 patients &#40;13 bilateral&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The demographic parameters &#40;age&#44; sex&#41;&#44; side of intervention&#44; radiological parameters &#40;Wiberg&#39;s angle or lateral centre edge angle&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a> angle of lateral coverage&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> acetabular index or T&#246;nnis angle<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> and joint interline of the coxo-femoral joint&#41; were determined as variables&#44; preoperatively and at the end of follow-up&#46; In addition&#44; complications &#40;transient dysaesthesia of the lateral femoral cutaneous nerve&#44; sciatic nerve paresis&#44; conversion to total hip prosthesis&#44; femoroacetabular impingement&#41; were measured during follow-up and functional results using the Non-Arthritic Hip Score<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> were measured preoperatively and at the end of the PAO follow-up&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0100" class="elsevierStylePara elsevierViewall">The patient is placed in a supine position on a radiolucent table&#46; Antibiotic prophylaxis &#40;cefazolin 2g&#41; and tranexamic acid &#40;1g&#41; are administered prior to surgery&#46; The anaesthetic&#44; general&#44; should be given with low doses of muscle relaxant &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In our centre this intervention is always performed with X-ray equipment &#40;OEC Fluorostar 7900 series&#44; GE OEC Medical Systems Inc&#44; Wendelstein&#44; Germany&#41;&#44; intraoperative neurophysiological monitoring&#44; a vascular surgeon and a continuous autotransfusion system &#40;Continuous AutoTransfusion System C&#46;A&#46;T&#46;S&#174; plus&#44; Fresenius Kabi AG&#44; Bad Homburg&#44; Germany&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The X-ray equipment is placed under the operating table&#44; and before placing the patient&#44; we must ensure anteroposterior &#40;AP&#41; and Lequesne&#39;s false profile views &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Intraoperative neurophysiological monitoring is performed by a neurophysiologist who records the motor and sensory activity of the abductor muscle groups&#44; rectus abdominis&#44; vastus medialis&#44; hamstrings&#44; gastrocnemius muscle&#44; long fibula&#44; posterior tibial and first toe adductor&#46; This allows us to monitor the motor and sensory signals of the femoral&#44; sciatic and obturator nerve&#44; while we perform osteotomies &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The presence of a vascular surgeon is due to the risk of injury to the corona mortis&#44; which is a retropubic anastomosis between the external iliac artery &#40;or deep epigastric vessels&#41; and the obturator artery&#46; This artery is usually located 1<span class="elsevierStyleHsp" style=""></span>cm medial to the pubic cut &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The surgical fields are then placed&#44; the trans-sartorial inguinal approach described by S&#246;balle &#40;Troelsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a>&#41; is carried out&#44; with special emphasis on the identification and subfascial release of the lateral femoral cutaneous nerve&#44; in order to provide maximum displacement&#44; and the osteotomies are performed in the following order&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1&#46;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Osteotomy&#44; with chisel&#44; from the iliopubic branch to 1<span class="elsevierStyleHsp" style=""></span>cm medial to the acetabulum&#46; It is performed by flexing the hip from 80&#176; to 90&#176; and a slight internal rotation to relax the iliacus psoas and the femoral nerve&#46; The osteotomy must be precise&#44; no more than 1<span class="elsevierStyleHsp" style=""></span>cm of the superolateral angle of the obturator foramen and is monitored by X-ray with AP and neutral and oblique inlet and outlet views &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2&#46;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Second osteotomy &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Osteotomy&#44; with chisel&#44; of the infra-acetabular fossa under fluoroscopic control with AP and Lequesne&#39;s views&#46; First a blunt dissection is performed with long Metzenbaum scissors to create a hole through which the Ganz or Matta osteotome can be introduced on the outer edge of the obturator hole&#46; The osteotomy must not go beyond the posterior cortex of the ischium&#46; It is important to keep approximately 1<span class="elsevierStyleHsp" style=""></span>cm in front of the posterior cortex of the ischium so as not to create a pelvic discontinuity&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3&#46;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Third osteotomy &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; A cut is made using the double-ended Ganz angled chisel&#44; 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; which connects a point halfway between the acetabular joint line and the sciatic spine&#46; This cut is made in Lequesne&#39;s alar view &#40;it will give us the length&#41; and anteroposterior &#40;it will give us the width&#41; and with the hip in flexion of 80&#176;&#8211;90&#176; with discrete external rotation to relax the sciatic nerve&#44; due to its proximity&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Fourth osteotomy &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The only cut that is performed with an oscillating saw and direct visualisation&#46; The osteotomy runs from the iliac wing&#44; below the anterosuperior iliac spine &#40;3&#46;5<span class="elsevierStyleHsp" style=""></span>cm supracetabular&#41;&#44; to 1<span class="elsevierStyleHsp" style=""></span>cm of the pelvic edge &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; It is controlled by fluoroscopy in AP pelvic view&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Fifth osteotomy &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Called &#8220;junction osteotomy&#8221;&#46; It goes from 1<span class="elsevierStyleHsp" style=""></span>cm from the pelvic wing to joining with the highest part of the third osteotomy&#46; This osteotomy&#44; in contrast to all the authors&#44; is performed with 2 Lambotte osteotomes&#44; and under fluoroscopic control with Lequesne&#39;s and AP view&#46; At this point the acetabulum is separated from the rest of the pelvis&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">6&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Acetabular reorientation&#46; This is the most complex step &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Sometimes&#44; the anaesthetist must induce additional muscle relaxation &#40;especially in very muscular patients&#41; in order to reorientate the acetabulum&#46; The goal is to obtain a slight medialisation of the acetabular fragment and lateral coverage&#44; and physiological anteversion as planned&#46; To this end&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">The centre of the femoral head should be located 4 or 5<span class="elsevierStyleHsp" style=""></span>mm from the posterior acetabular rim&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">The anterior acetabular rim should not cross the posterior rim and should be projected approximately at 1&#47;3 from the posterior wall&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">The sciatic spine should not be visible in the strict AP view &#40;which would mean retroversion&#41; and the second osteotomy &#40;infra-acetabular-ischium&#41; should have seen angulation corresponding to that achieved in the femoral head coverage&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">7&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Acetabular fixation &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; We use 2 or 3 4&#46;5<span class="elsevierStyleHsp" style=""></span>mm bicortical screws &#40;Matta Pelvic System&#44; Stryker Trauma AG&#44; Selzach&#44; Switzerland&#41; varying from 60 to 140<span class="elsevierStyleHsp" style=""></span>mm in length&#44; starting from lateral to medial in an inverted V&#46; During fixation we perform AP and Lequesne&#39;s views to ensure that we do not invade the coxo-femoral joint</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">Closure is in planes &#40;taking care not to trap the lateral femoral cutaneous nerve&#41;&#44; we do not use drains&#44; and for the skin we use continuous intradermal absorbable suture&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Postoperative follow-up and rehabilitation protocol</span><p id="par0170" class="elsevierStylePara elsevierViewall">For postoperative pain we use a local intralesional catheter for the first 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h to inject 20<span class="elsevierStyleHsp" style=""></span>cc bolus containing 10<span class="elsevierStyleHsp" style=""></span>cc of 0&#46;7&#37; Ropivacaine&#44; 9<span class="elsevierStyleHsp" style=""></span>cc of saline and 1<span class="elsevierStyleHsp" style=""></span>cc of ketorolac &#40;30<span class="elsevierStyleHsp" style=""></span>mg&#41; every 8<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Additional rescue analgesia may be used&#44; if required&#44; or even a patient-controlled analgesia pump system may be applied&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The length of hospital stay is usually 6&#8211;8 days&#46; With the patient haemodynamically stable &#40;no haemoglobin loss below 3<span class="elsevierStyleHsp" style=""></span>g&#47;l is expected&#41; rehabilitation is usually started on the first postoperative day&#46; In the first 6 weeks passive pendulum movements and gradual&#44; gentle kinesitherapy are performed without exceeding 90&#176; flexion&#44; 40&#176; abduction&#44; 60&#176; external rotation&#44; 20&#176; adduction and 20&#176; internal rotation &#40;an excess of internal rotation would greatly force acetabular fixation&#41;&#46; In addition&#44; isometric quadriceps&#44; gluteus maximus and gluteus medius exercises are performed&#46; Walking starts with partial weight-bearing from 48<span class="elsevierStyleHsp" style=""></span>h with the help of 2 English canes&#46; According to the radiological progress&#44; in the seventh week the external support is removed from the operated side and in the ninth week walking without external support and strengthening of the pelvitrochanteric musculature begins&#46; From the eleventh week&#44; proprioception exercises are performed&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Check-ups are carried out at 3&#44; 6 and 12 weeks post-operatively&#44; where a physical examination and radiological control is performed through antero-posterior and false Lequesne profile views&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0185" class="elsevierStylePara elsevierViewall">Stata version 12&#46;0 for Macintosh &#40;Data Analysis and Statistical Software&#44; Texas&#44; USA&#41; was used for the statistical analysis&#46; A descriptive study of the variables was performed&#44; and they were expressed in means and standard deviation &#40;SD&#41;&#46; In addition&#44; the Shapiro&#8211;Wilk test was used to confirm the normal distribution of variables&#46; When the normal distribution could not be confirmed or the requirements to perform the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired data were not met&#44; a non-parametric test&#44; the Wilcoxon test&#44; was used&#46; A probability level of &#46;05 was accepted as the criterion for statistical significance for all statistical tests and the confidence intervals were calculated&#44; where possible&#44; at a 95&#37; confidence level&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0190" class="elsevierStylePara elsevierViewall">The mean age of the patients was 32&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 &#40;SD&#41; years&#44; 102 &#40;77&#46;9&#37;&#41; were women and 29 &#40;22&#46;1&#37;&#41; were men&#46; Fifty-three point four percent &#40;70&#41; of the PAOs were performed on the right side and 46&#46;5&#37; &#40;61&#41; on the left&#46; The mean follow-up was 7&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 &#40;SD&#41; years&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">With regard to the radiological results &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; the Wiberg&#39;s angle went from 18&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;6 &#40;SD&#41; to 36&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;83 &#40;SD&#41;&#46; The change was statistically significant with a gain in coverage of &#43;18&#46;5 &#40;95&#37; CI 17&#46;26&#8211;19&#46;74&#59; Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired samples&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41;&#46; The anterior coverage angle increased from 26&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;71 &#40;SD&#41; to 39&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 &#40;SD&#41; at the end of follow-up&#46; Thus&#44; a gain was obtained of&#43;13&#46;5 &#40;95&#37; CI 11&#46;6&#8211;15&#46;42&#59; Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired samples&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41;&#46; The acetabular index improved from 19&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4 &#40;SD&#41; to 8&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 &#40;SD&#41; at the end of the follow-up&#46; This reduction was also statistically significant &#40;&#8722;11&#46;1&#44; 95&#37; CI &#8722;12&#46;13 to &#8722;10&#46;12&#59; Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired samples&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">With regard to the functional results the NAHS improved from 60&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;42 &#40;SD&#41; points to 92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3 &#40;SD&#41;&#44; the increase being &#43;31&#46;3 points &#40;95&#37; CI&#58; 28&#46;7&#8211;33&#46;8&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the cervical-diaphyseal femoral angle&#44; the joint space and the degree of joint degeneration according to the T&#246;nnis scale&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">We had complications in 20 cases &#40;15&#46;26&#37;&#41; of the 131 included in the study&#44; which we differentiated into minor &#40;not requiring second surgery&#41; and major &#40;requiring second surgery&#41;&#46; Minor complications &#40;12&#46;21&#37;&#41;&#58; the most frequent complication was transient lateral femoral cutaneous nerve dysaesthesia &#40;LFN&#41;&#44; which occurred in 10 cases &#40;58&#37; overall of all complications&#41;&#46; In addition&#44; we had one case with sympathetic algodystrophy&#44; one case of coxa saltans&#44; one case of asymptomatic pseudoarthrosis of the iliopubic branch&#44; one case of superficial skin infection that resolved with antibiotic therapy&#44; one case of transient paresis of the external branch of the sciatic nerve that resolved with medical and rehabilitative treatment in less than one year&#44; one case of delayed consolidation of the posterior spine&#44; and one case of gluteal midline tendinitis&#46; Major complications &#40;2&#46;29&#37;&#41;&#58; none of them neurovascular&#46; In one case required conversion to short-stem total hip arthroplasty with ceramic-on-ceramic pair&#44; and 2 cases with an alpha-femoral angle of more than 55&#176; required conversion to mini open femoral-acetabular osteoplasty&#46; These latter complications are now directly avoided by combining PAO with arthroscopic femoral osteoplasty&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In terms of the degree of progression according to the T&#246;nnis scale&#44; we observed that 37&#46;6&#37; of the patients with T&#246;nnis 0 progressed to T&#246;nnis 1&#44; and 9&#46;8&#37; of the patients with T&#246;nnis 1 progressed to T&#246;nnis 2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0215" class="elsevierStylePara elsevierViewall">This retrospective study evaluates functional results and acetabular orientation capacity by means of mini-invasive PAO and found that patients treated with this technique achieve correct acetabular coverage with few complications and with a significant improvement in functional results&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">There are few national studies that assess results following a PAO&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">19&#44;20</span></a> and of these only the study by D&#237;az et al&#46;19 performs PAO according to the technique described by Ganz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> using the modified Smith-Petersen approach and not the mini-invasive approach described by Troelsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> In 2007 we learned from Professor S&#248;balle about the mini-invasive approach&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> and because of its advantages &#40;same acetabular orientation capacity&#44; reduced surgical time&#44; very moderate blood loss &#91;in our case no more than 500<span class="elsevierStyleHsp" style=""></span>cc&#44; which was retransfused once filtered&#93;&#41;&#44; less postoperative pain&#44; less soft tissue manipulation and lower proportion of complications&#58; we have been using this type of approach ever since&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Our results&#44; with the mini-invasive approach&#44; are similar and comparable to those reported in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;21&#44;22</span></a> and to those with an established experience curve that use the modified Smith-Petersen approach&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;7&#44;10&#44;22&#44;23</span></a> We found&#44; at the end of the follow-up&#44; a Wiberg&#39;s angle of 36&#46;8 and an acetabular index of 8&#46;4 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Troelsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> conducted a study that analysed 263 PAO &#40;165 using the mini-invasive approach and 98 using the ilioinguinal approach&#41; and observed similar correction with both approaches&#44; but there were more advantages with the mini-invasive approach than with the ilioinguinal approach&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> We cannot compare our results with the results of PAOs using the ilioinguinal approach&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;11&#44;19</span></a> because it is not the same approach&#44; and they also use different functional scales to those we have used&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Nevertheless&#44; considering that our work is not comparative&#44; based on the literature we were able to assess the advantages of the mini-invasive approach in relation to other approaches&#44; which comprise&#44; according to Troelsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> less muscle damage with selective involvement of the sartorius muscle&#44; less surgical time due to less time for the approach and closure&#46; When the trans-sartorius mini-invasive approach is performed&#44; the sartorius and iliopsoas muscles protect the femoral vessels and nerves from indirect injury&#44; which is why the reported prevalence of moderate and severe neurovascular injuries is zero &#40;0&#37;&#41;&#44; compared to the iliofemoral approach&#44; where the prevalence of moderate and severe neurovascular injuries is 2&#37;&#8211;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> In relation to blood loss&#44; the literature reports a loss of approximately 0&#46;7&#8211;2<span class="elsevierStyleHsp" style=""></span>l&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;23</span></a> using the modified Smith-Petersen approach&#44; according to the results reported by Trousdale and Cabanela&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> mean blood loss was 350<span class="elsevierStyleHsp" style=""></span>ml&#44; and using the trans-sartorial mini-invasive approach the mean loss was approximately 2l6&#46; Regarding the transfusion requirement&#44; Troelsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> using the mini-invasive approach&#44; describe that it was necessary in approximately 3&#37; of the procedures&#44; while Bryan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> using the modified Smith-Petersen approach&#44; describe a transfusion rate of approximately 21&#37;&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">However&#44; we observe that&#44; regardless of the approach used&#44; PAO improves the patient&#39;s functional status&#46; Alcob&#237;a D&#237;az et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> obtained 14&#46;3 points on the Merle-D&#8217;Aubigne-Postel scale out of a possible 18&#44; corresponding to a good outcome&#46; Steppacher et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> observed that after 20 years of follow-up&#44; the patients achieved a score of 15&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1 points out of a possible 18 on the Merle-D&#8217;Aubigne-Postel scale&#46; Using the Harris Hip Score&#44; Peters et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> obtained an improvement from 54 &#40;range&#44; 20&#8211;81&#41; points preoperatively to 87 &#40;range&#44; 49&#8211;100&#41; points at the end of follow-up&#46; We&#44; with the NAHS scale&#44; obtained an increase in the score from 60&#46;7 points preoperatively to 92 points at the end of follow-up &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Progression of coxarthrosis can occur in from 5&#37; to 33&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;28</span></a> In our results we observed that 37&#46;6&#37; of patients with T&#246;nnis 0 progressed to T&#246;nnis 1 and 9&#46;8&#37; of patients with T&#246;nnis 1 progressed to T&#246;nnis 2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Alcob&#237;a D&#237;az et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> observed that an increase of at least one degree on the T&#246;nnis scale occurred in 20&#37; of patients at 5 years of follow-up&#44; and 54&#37; at 10 years&#46; Matta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> demonstrated a progression of coxarthrosis by 21&#37; in patients with T&#246;nnis 1&#44; 35&#37; with T&#246;nnis 2 and 83&#37; for T&#246;nnis 3&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The complication rate is related to the learning curve of the orthopaedic surgeon&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> In general&#44; PAO carries a high risk of developing some type of complication&#46; Complications and their severity&#44; such as neurological or vascular lesions&#44; occur at very low rates in the hands of expert surgeons according to Zaltz et al&#46; and the ANCHOR group<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#59; there is a 5&#46;9&#37; chance of complications that would involve further surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The ANCHOR group classifies complications into 5 grades&#58; grade I are those that do not require treatment and do not impair the postoperative course&#44; grade II are those that impair the normal postoperative course&#44; requiring pharmacological treatment or more frequent controls&#44; grade III are those that require surgical intervention and unplanned re-admission&#44; grade IV are those that are life-threatening if not treated or that have the potential for permanent disability&#44; and grade V are complications that cause death&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Wells et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> conducted a study involving 154 PAOs using the method described by Ganz<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> with a minimum follow-up of 4 years&#46; They observed that 66 of the 154 PAOs &#40;42&#46;8&#37;&#41; developed some complication&#44; the most frequent were those that did not require postoperative treatment &#40;48&#46;31&#37;&#41;&#44; such as the presence of asymptomatic heterotopic ossification&#44; asymptomatic non-union or dysaesthesia of the LFC nerve&#46; Troelsen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> when comparing the mini-invasive approach with the ilioinguinal approach observed that in the ilioinguinal group there were 3&#47;98 cases of arterial thrombosis&#44; while in the mini-invasive group there were no neurovascular complications or moderate&#47;severe complications deriving from the technique&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">We had complications in 20&#47;131 cases &#40;15&#37;&#41;&#46; The most frequent complication &#40;7&#46;63&#37;&#41; was temporary dysaesthesia of the LFC nerve&#44; a grade I complication according to ANCHOR&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> which resolved satisfactorily in all patients during follow-up&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Five percent of complications were grade II&#46; One case with sympathetic algodystrophy&#44; one case of coxa saltans&#44; one case of asymptomatic pseudoarthrosis of the pubic ramus&#44; one case of superficial skin infection&#44; one case of transient sciatic nerve paresis&#44; one case of delayed consolidation and one case of gluteal midline tendinitis&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Only 3&#47;131 cases &#40;2&#46;29&#37;&#41; had grade III complications according to the ANCHOR criteria&#44; requiring postoperative surgical treatment &#40;one conversion to total hip prosthesis and 2 osteoplasties due to femoroacetabular impingement using the mini-invasive technique&#41;&#46; As an adjuvant treatment&#44; when femoroacetabular impingement occurs after a PAO&#44; surgical treatment offers satisfactory results&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">32&#8211;34</span></a> We had no complications that could be classified as grade IV or V&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Long-term cohort survival has been reported&#46; Steppacher et al&#46; describe 60&#37; survival in their series at 20 years of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a>Similarly&#44; as reported by Ziran et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> 60&#37; of patients undergoing PAO maintain their native hip after 20 years of follow-up&#46; Although conversion from a PAO to a total hip arthroplasty &#40;THA&#41; could be considered a therapeutic failure&#44; it should not be seen as such&#44; but rather as an adjunct to THA&#46; Baqu&#233; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> concluded that PAOs prior to THA optimise patient recovery and provide greater stability to the hip&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">We acknowledge that our study has certain limitations&#46; First&#44; it is a retrospective study and therefore has the inherent limitations of this type of study&#46; Second&#44; we did not conduct a comparative study with other PAO techniques&#44; we focussed only on the technique used at our centre&#46; Third&#44; we did not analyse whether age influenced the progression of degenerative changes according to the T&#246;nnis scale&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">In summary&#44; based on our results&#44; we have described our series of patients treated for DDH using mini-invasive PAO&#44; describing their functional results&#44; the technical steps of the procedure based on our experience&#44; and the complications related to the procedure&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0290" class="elsevierStylePara elsevierViewall">Peri-acetabular osteotomy using the mini-invasive approach is a reproducible technique&#44; allowing restoration of acetabular coverage and providing improvement on the functional scales&#44; as confirmed in our series&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">With a low complication rate that we understand&#44; and this is also reflected in the literature&#44; this is a safe procedure in the hands of expert surgeons&#46; Our data suggest that most of these complications are not associated with the need for further surgical procedures&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">We strongly believe in the need to extend our expertise to a greater number of hip surgeons interested in the mini-invasive treatment of residual dysplasia in children and young adults&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Level of evidence</span><p id="par0305" class="elsevierStylePara elsevierViewall">Level of evidence III&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0310" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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              "titulo" => "Postoperative follow-up and rehabilitation protocol"
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    "fechaRecibido" => "2019-08-12"
    "fechaAceptado" => "2020-01-18"
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            0 => "Periacetabular osteotomy"
            1 => "Residual hip dysplasia"
            2 => "Hip"
            3 => "Hip preservation surgery"
            4 => "Mini-invasive surgery"
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            0 => "Osteotom&#237;a periacetabular"
            1 => "Displasia residual de cadera"
            2 => "Cadera"
            3 => "Cirug&#237;a de preservaci&#243;n de cadera"
            4 => "Cirug&#237;a m&#237;nimamente invasiva"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Periacetabular osteotomy &#40;PAO&#41; is an accepted and worldwide technique recognised for residual dysplasia treatment and even in unstable hips with limited acetabular coverage&#46; The aim of this study is to analyse the functional&#44; radiological and complication results in patients treated with mini-invasive PAO&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study in which we analysed 131 cases undergoing mini-invasive PAO at our centre&#46; The degree of joint degeneration was evaluated with T&#246;nnis scale&#44; Wiberg angle&#44; acetabular index &#40;AI&#41;&#44; anterior coverage angle &#40;AC&#41;&#44; joint space&#44; complications and functional outcome with the Non-Arthritic Hip Score &#40;NAHS&#41; were analysed preoperatively and at the end of follow-up&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The average age was 32&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 &#40;SD&#41; years&#44; 102 &#40;77&#46;9&#37;&#41; were female and 29 &#40;22&#46;1&#37;&#41; were male&#46; 7&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 &#40;SD&#41; years follow up&#46; The radiological parameters improved between the pre-surgical phase and the end of follow-up&#44; Wiberg angle &#43;18&#46;5&#176; &#40;18&#46;3&#176; versus 36&#46;8&#176;&#44; 95&#37; CI 17&#46;3&#8211;19&#46;7&#41;&#44; AC angle &#43;13&#46;5&#176; &#40;26&#46;2&#176; versus 39&#46;7&#176;&#44; 95&#37; CI 11&#46;6&#8211;15&#46;4&#41; and the AI &#8722;11&#46;1&#176; &#40;19&#46;5&#176; versus 8&#46;4&#176;&#59; 95&#37; CI &#8722;12&#46;1 to &#8722;10&#46;1&#41;&#46; In addition&#44; the functional results&#44; with the NAHS scale&#44; improved &#43;31&#46;3 points &#40;60&#46;7 pre-surgical versus 92 at the end of follow-up&#44; 95&#37; CI 28&#46;7&#8211;33&#46;8&#41;&#46; The most common complication was transient lateral femoral cutaneous nerve hypoaesthesia in 10 cases &#40;7&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The mini-invasive PAO approach is a reproducible technique&#44; it allows restoration of acetabular coverage and provides an improvement in functional scales as confirmed by our series&#46;</p></span>"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La osteotom&#237;a periacetabular &#40;OPA&#41; es una t&#233;cnica utilizada para el tratamiento de la displasia residual&#44; incluso en caderas inestables con cobertura acetabular limitada&#46; El objetivo de este estudio es analizar los resultados funcionales&#44; radiol&#243;gicos y las complicaciones en pacientes tratados mediante OPA mini-invasiva&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo que analiza 131 casos intervenidos con OPA en nuestro centro&#46; Se determin&#243; de forma prequir&#250;rgica y al final del seguimiento el grado de degeneraci&#243;n articular con la escala de T&#246;nnis&#44; el &#225;ngulo de Wiberg&#44; el &#237;ndice acetabular&#44; el &#225;ngulo de cobertura anterior&#44; el espacio articular&#44; las posibles complicaciones y el resultado funcional mediante la escala <span class="elsevierStyleItalic">Non-Arthritic Hip Score</span>&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media de 32&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;5 &#40;DE&#41; a&#241;os&#44; 102 &#40;77&#44;9&#37;&#41; fueron mujeres y 29 &#40;22&#44;1&#37;&#41; fueron hombres&#46; El seguimiento fue de 7&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8 &#40;DE&#41; a&#241;os&#46; Se obtuvo una mejora en los par&#225;metros radiol&#243;gicos entre el momento prequir&#250;rgico y al final del seguimiento&#44; &#225;ngulo de Wiberg de<span class="elsevierStyleHsp" style=""></span>&#43;18&#44;5&#176; &#40;18&#44;3&#176; versus 36&#44;8&#176;&#44; IC 95&#37;&#58; 17&#44;3 a 19&#44;7&#41;&#44; &#225;ngulo de cobertura anterior de<span class="elsevierStyleHsp" style=""></span>&#43;13&#44;5&#176; &#40;26&#44;2&#176; versus 39&#44;7&#176;&#44; IC 95&#37;&#58; 11&#44;6 a 15&#44;4&#41; y el &#237;ndice acetabular de &#8211;11&#44;1&#176; &#40;19&#44;5&#176; versus 8&#44;4&#176;&#59; IC 95&#37;&#58; &#8211;12&#44;1 a &#8211;10&#44;1&#41;&#46; Adem&#225;s&#44; los resultados funcionales con la escala <span class="elsevierStyleItalic">Non-Arthritic Hip Score</span> mejoraron en<span class="elsevierStyleHsp" style=""></span>&#43;31&#44;3 puntos &#40;60&#44;7 prequir&#250;rgico versus 92 &#250;ltimo seguimiento posquir&#250;rgico&#59; IC 95&#37;&#58; 28&#44;7 a 33&#44;8&#41;&#46; La complicaci&#243;n m&#225;s frecuente fue la disestesia transitoria del nervio f&#233;moro-cut&#225;neo lateral en 10 casos &#40;7&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La osteotom&#237;a periacetabular mediante el abordaje mini-invasivo es una t&#233;cnica reproducible&#44; permite restaurar la cobertura acetabular y proporciona una mejora en las escalas funcionales seg&#250;n confirma nuestra serie&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Ram&#237;rez-N&#250;&#241;ez L&#44; Payo-Ollero J&#44; Comas M&#44; C&#225;rdenas C&#44; Bellotti V&#44; Astarita E&#44; et al&#46; Osteotom&#237;a periacetabular en el tratamiento de displasia de cadera mediante t&#233;cnica mini-invasiva&#46; Nuestros resultados a medio plazo en 131 casos&#46; Rev Esp Cir Ortop Traumatol&#46; 2020&#59;64&#58;151&#8211;159&#46;</p>"
      ]
    ]
    "multimedia" => array:8 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">First osteotomy&#59; pubic osteotomy immediately after the teardrop&#46; Supervised by antero-posterior pelvic X-rays&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Second osteotomy&#59; infra-acetabular fossa&#44; 1<span class="elsevierStyleHsp" style=""></span>cm ventral to the posterior ischial cortex Supervised by antero-posterior and Lequesne&#39;s X-rays&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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            "Tamanyo" => 135861
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Third osteotomy&#59; lower posterior spine&#44; directed at a point from 2<span class="elsevierStyleHsp" style=""></span>cm ventral to the sciatic spine through an imaginary midline between the coxofemoral joint and the posterior ischial cortex&#46; Supervised by Lequesne&#39;s and AP pelvic views&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 860
            "Ancho" => 2175
            "Tamanyo" => 168382
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Fourth osteotomy&#44; iliac wing immediately below the anterior superior iliac spine towards 1<span class="elsevierStyleHsp" style=""></span>cm of the pelvic rim&#46; Supervised by AP pelvic projection&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 655
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            "Tamanyo" => 165093
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Fifth osteotomy or &#8220;connection osteotomy&#8221;&#59; joins by a straight line the third and fourth osteotomies by a straight line&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Fixation of fragments with 2 or 3 stainless steel cortical self-tapping screws of 4&#46;5<span class="elsevierStyleHsp" style=""></span>mm diameter and a length of 60&#8211;140<span class="elsevierStyleHsp" style=""></span>mm&#44; in an inverted-V arrangement&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pre-operatively</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pre-operative planning of the peri-acetabular cuts and the expected acetabular orientation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Radiological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>X-ray equipment must be able to move from an AP view to a Lequesne&#39;s false profile&#46; Otherwise&#44; we will not be precise in carrying out each of the cuts that make up the PAO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lequesne&#39;s false profile requires a 30&#176;&#8211;40&#176; slope&#44; allowing for better exposure of the posterior spine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Modifying the height of the surgical table allows increased frontal view with the X-ray equipment&#44; to allow centring of the pubic symphysis&#44; in an attempt to make it as similar as possible to the orthostatic pelvic X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neurological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Collaboration from a neurophysiologist to monitor the motor and sensory responses of the femoral&#44; sciatic and obturator nerve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vascular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Collaboration from a vascular surgeon due to risk of injury to the corona mortis which is usually located at 1<span class="elsevierStyleHsp" style=""></span>cm medial to the pubic cut&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Use a system of continuous autotransfusion to minimise blood loss during the procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Surgical</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Position the patient in supine position on a radiolucent table&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General anaesthesia with a low dose of muscle relaxant so as not to interfere with the neurophysiological measurements&#46; Epidural anaesthesia is not recommended as it could mask a vascular and neurological complication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteotomes must always be sufficiently sharp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Follow the strict order of the osteotomies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Do not over pull the iliopsoas muscle&#44; which can damage the lateral femoral cutaneous nerve and the femoral nerve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>During the 2nd&#44; 3rd and 5th cut the hip should rest with a slight external rotation of 20&#176;&#8211;30&#176; and 90&#176; knee flexion to move laterally and keep the sciatic nerve and gluteal arteries relaxed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>In the 4th cut it could be useful to demarcate the osteotomy by inserting a Kirschner wire next to the cortex of the lateral ilium&#44; and to use a blunt retroverted radiolucent retractor to protect the upper gluteal vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Do not place the blunt retroverted retractor too high so as not to damage the lumbar plexus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acetabular reorientation should be performed with the hip in flexion&#46; If performed in extension&#44; the capsule and iliofemoral ligaments are tightened and this could lead to retroversion of the fragment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>For acetabular reorientation the Hern&#225;ndez-Ros clamp or an 8<span class="elsevierStyleHsp" style=""></span>mm threaded bicortical Schanz screw used in the form of a joystick can be helpful&#46; It should be placed in the most super-medial part of the fragment so as not to force it&#59; otherwise there is a risk of unexpected rupture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Postoperative pain</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Use a local intralesional catheter for the first 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h to inject a bolus of 20<span class="elsevierStyleHsp" style=""></span>cc containing 10<span class="elsevierStyleHsp" style=""></span>cc of ropivacaine &#46;7&#37;&#44; 9<span class="elsevierStyleHsp" style=""></span>cc of saline and 1cc of ketorolac &#40;30<span class="elsevierStyleHsp" style=""></span>mg&#41; every 8<span class="elsevierStyleHsp" style=""></span>h&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Presurgical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Last follow-up<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wiberg&#39;s angle<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&#44; degrees&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;18&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;42&#8211;19&#46;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T&#246;nnis angle<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&#44; degrees&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;43&#8211;15&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Acetabular index&#44; degrees&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;12&#46;3 to &#8722;10&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coxofemoral joint space&#44; mm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;&#46;86 to &#8722;&#46;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Non-Arthritic Hip Score</span>&#44; points&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">60&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">90&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#43;30&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&#46;83&#8211;33&#46;29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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Article information
ISSN: 19888856
Original language: English
DOI:10.1016/j.recote.2020.03.010
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