Journal article
Peri-Operative Management of Periacetabular Osteotomy: A Report of Current Practices from the Anchor Group, Supporting Literature, and Areas for Future Investigation
The Iowa orthopaedic journal, Vol.44(1), pp.159-166
01/01/2024
PMCID: PMC11195894
PMID: 38919350
Appears in Diamond Open Access
Abstract
Background
Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies on early pain and function. The purpose of this study is to describe peri-operative management variability among a group of experienced surgeons and review the literature supporting these practice patterns.
Methods
We surveyed 16 surgeons that perform PAO to document various aspects of peri-operative management at four stages: pre-operative, intra-operative, post-operative in the hospital, and at discharge. Our goal was to report current surgical pain management strategies, adjunct medications, type of anesthesia, deep venous thrombosis and heterotopic ossification prophylaxis strategies, initiation of physical therapy, and use of continuous passive motion (CPM). We reviewed current literature to identify studies supporting these perioperative strategies and identify knowledge gaps that would benefit from further investigation.
Results
Of the 16 surgeons surveyed, 75% had been in practice greater than 10 years and most had not altered their post-operative protocol for more than 3 years. 15/16 surgeons felt that length of stay could be reduced at their institution with improved peri-operative pain management. 6/16 were considering or had already implemented outpatient PAO as a part of their practice. We found significant variability in the pain medications provided at all peri-operative stages. 14/16 utilized general anesthesia, and many utilized epidural or peripheral nerve blocks. 6/16 surgeons utilized surgical field block (also referred to as periarticular block). These surgeons advocated that surgical field block was an effective intervention with no/minimal complication risk. There is very little literature critically evaluating efficacy of these perioperative management strategies for PAO.
Conclusion
There is significant practice variability in peri-operative management of PAO surgery. We report various strategies utilized by a group of experienced surgeons and review supporting literature. There are significant knowledge gaps in best surgical pain management strategies, adjunct medications, surgical field blocks, and use of CPM that need further investigation.
Level of Evidence: IV
Details
- Title: Subtitle
- Peri-Operative Management of Periacetabular Osteotomy: A Report of Current Practices from the Anchor Group, Supporting Literature, and Areas for Future Investigation
- Creators
- Michael Willey - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAAndrea M. Spiker - University of Wisconsin School of Medicine and Public HealthMatthew R. Schmitz - Rady Children's Hospital-San DiegoEtienne L. Belzile - Université LavalRafael J. Sierra - Mayo ClinicJohn Clohisy - Washington University in St. LouisMichael Stover - Northwestern University
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.44(1), pp.159-166
- PMID
- 38919350
- PMCID
- PMC11195894
- NLM abbreviation
- Iowa Orthop J
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- Language
- English
- Date published
- 01/01/2024
- Academic Unit
- Orthopedics and Rehabilitation; Injury Prevention Research Center
- Record Identifier
- 9984649042602771
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