EP1.38 The “Stacked Osteotomy” technique in periacetabular osteotomy: A safe efficient method to mobilize the fragment

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ID: 331377
2026
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Abstract
Abstract Introduction/ Objectives The retroacetabular osteotomy in periacetabular osteotomy (PAO) represents the final and critical step required to fully mobilize the acetabular fragment. Traditionally, this cut is performed using a single straight or curved osteotome, connecting the supraacetabular and ischial osteotomies, which may leave a residual bony bridges in the thick region of the iliac brim and the posterolateral vicinitiy of the ischium, often requiring mobilization from inside the pelvis using an angled osteotome. Stacked osteotomes pointing towards the postero-inferior hinge, concentrate the distraction forces of the osteotome, allowing for controlled propagation and connection of the osteotomy lines. Furthermore, the osteotomes displace the inferior portion of the mobile fragment anteriorly, cracking residual bony bridges. This study evaluated whether a technique employing stacked osteotomes provides a safe and time-efficient alternative for performing the retroacetabular cut in PAO compared to the conventional technique. Methods A consecutive series of 283 PAOs performed between January 2025 and January 2026 by a single surgeon were reviewed. The stacked osteotomy technique was applied in 140 PAOs. These cases were compared with 120 PAOs in which a conventional retroacetabular osteotomy was performed, with respect to surgical time, blood loss, and the additional need for an inside-out osteotomy to fully mobilize the fragment. Adverse events were also noted. Results Operative time was significantly shorter in the stacked osteotomy group compared to the conventional group (47.96 ± 16.5 min vs. 53.21 ± 17.22 min), corresponding to a reduction of 9.85 % (p = 0.013). Estimated blood loss, calculated using the Gross formula, was lower by 3.33 % in the stacked osteotomy group. However, this difference did not reach statistical significance (p = 0.48). The need of an additional inside-out osteotomy was significantly higher in conventional osteotomy group (76.67 % vs. 56.43 %, p < 0.001), corresponding to an odds ratio of 2.54. No major complications, such as vascular injury, femoral or sciatic nerve injuries or ischial fractures, were observed in either group. Conclusions The use of the stacked osteotomy technique to perform the retroacetabular cut in PAO surgery is a safe, reproducible and time-efficient technique easing the demanding step of the retroacetabular cut in PAO surgery. The reduction in the need for an inside-out osteotomy to free the posteroinferior bony bridges may be considered protective to the sciatic nerve and articular penetration.
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Authors med Marco Haertlé, Nicola Pohly, Quentin Karisch, med Chiara Heller, Justus Stamp, med Sufian S Ahmad
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.222
URL
https://doi.org/10.1093/jhps/hnag043.222
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