How to minimize complications during and after periacetabular osteotomy

Listen to Lisa and Brian discuss the paper 'How to minimize complications during and after periacetabular osteotomy' published in the October 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we'll be discussing the paper 'How to minimize complications during and after periacetabular osteotomy: lessons learned from over 700 patients with and without concomitant hip arthroscopy' published in October 2025 by W Tai and colleagues. I'm Lisa, and with me is my co-host Brian. 

Hello everyone, we've got a fascinating and detailed study to explore today, so let's get started. Lisa, could you briefly explain what a periacetabular osteotomy or PAO is and its purpose? 

Of course! PAO is a surgical procedure aimed at treating hip dysplasia by repositioning the acetabulum to improve coverage of the femoral head and redistribute mechanical loads across the joint surface. This can help slow the progression of osteoarthritis associated with hip dysplasia. 

The study aimed to assess the types and [00:01:00] rates of complications following PAO, correct? Precisely. The study involved 715 consecutive patients who underwent unilateral PAO from December 2006 to January 2024. The authors aim to identify complications using the modified Clavien-Dindo system. 

That's quite a comprehensive data set. What were some of the main findings in terms of complications? 

Out of the 715 patients, 121 experienced 144 complications. These were graded as 68 grade I, 52 grade II, 23 grade III, one grade IV and no grade V complications. The study revealed that complications mainly involved wound issues, nerve injuries, and heterotopic ossification among other things. 

Were there any notable risk factors for these complications? Yes. Age was a significant factor. Patients under 20 had a [00:02:00] lower risk of complications. However, those with a smoking history or those needing correction of both acetabular dysplasia and retroversion had an increased risk of complications. 

Interesting. I noted that operating time in the surgeon's experience also played a role. Is that right? 

Correct. The study indicated that as the surgeon gained more experience. Both the operating time and the incidence of complications decreased. This highlights the learning curve associated with PAO. 

What practical insights or recommendations did the study offer for minimizing these complications? Several key recommendations were made. These include meticulous surgical technique, thorough preoperative planning, and specific intraoperative practices like using fluoroscopy to guide the osteotomies, careful retraction to avoid nerve damage and postoperative management strategies such as promoting smoking cessation and weight management. 

Those sound like solid strategies to improve patient outcomes. Were there [00:03:00] surgical techniques or protocols that stood out to you? 

The study stressed the importance of using a modified Smith-Petersen approach to protect the lateral femoral cutaneous nerve. Hip arthroscopy was also performed to address chondrolabral damage showing no increase in complication rates when combined with PAO. 

That's reassuring. How about the overall effectiveness of PAO as a procedure? PAO was found to be effective and comes with an acceptable complication rate. The study concluded that with proper patient optimization and meticulous surgical technique, the risk can be significantly minimized, ensuring better patient safety and outcomes. 

That's a crucial takeaway. Before we wrap up, let's summarize the main insights for our listeners. Certainly Brian. 

The main insights are PAO is a complex yet effective procedure for treating hip dysplasia. Key risk factors for complications include age over 20, smoking history, and combined corrections of [00:04:00] dysplasia and retroversion. Surgeon experience significantly reduces complications. Finally, patient optimization and meticulous surgical techniques are crucial for minimizing risks. 

Thanks, Lisa. Well, that's all the time we have for today's episode. Thank you for tuning into AI talks with Bone & Joint. Yes, thank you all for joining us.