EP9.21 Protecting the Sciatic Nerve During Periacetabular Osteotomy: Techniques Currently Taught in Hip Preservation Fellowship Programs

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ID: 331390
2026
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Abstract
Abstract Background Direct sciatic nerve injury (DSNI), though rare, remains one of the most devastating complications of periacetabular osteotomy (PAO), with fewer than half of affected patients recovering full motor function. Dual-approach techniques enable direct visualization and protection of the sciatic nerve through a dedicated posterior approach and have been associated with lower rates of DSNI compared to single anterior approaches, which rely on indirect protective strategies. Despite this, many early-career hip preservation surgeons utilize a single anterior approach, potentially reflecting patterns of exposure and familiarity established during fellowship training. Accordingly, we sought to characterize the spectrum of sciatic nerve protection strategies taught across hip preservation fellowships and determine the extent to which fellows are exposed to the dual-approach. Methods Hip preservation fellowships teaching PAO were identified using the ISHA directory, program director queries, and online searches. Program directors completed a survey assessing which PAO approaches, including single-incision or dual (anterior and posterior) incision techniques are taught to fellows intraoperatively. Programs teaching only single-incision approaches were asked follow-up questions about DSNI prevention steps, fellow exposure to the posterior approach through other means (cadaver studies, lectures, courses), and interest in a one- or two-day posterior approach course. Results Twenty-one hip preservation fellowships were identified across North America, South America, Europe, and Australia. Thirteen program directors responded (response rate: 61.9%). The Smith-Petersen or modified Smith-Petersen approach was most common (n=8, 61.5%), followed by ilioinguinal (n=3, 23.1%) and dual anterior-posterior approaches (n=3, 23.1%). Among programs teaching single anterior approaches only, DSNI prevention techniques varied and included hip extension and external rotation during cuts, 45-degree hip flexion during cuts, and intraoperative imaging or fluoroscopy to avoid posterior column penetration. Of the 10 programs exclusively teaching a single anterior approach, only 2 (20%) expose fellows to the posterior approach through other means, while 5 (50%) expressed interest in a dedicated dual-approach course. Conclusion Sciatic nerve protection during PAO is taught with considerable variability, and fellowship training remains largely centered on single anterior approaches. Growing interest in dual-approach training suggests an opportunity to expand fellowship curricula and enhance exposure to evolving strategies aimed at mitigating DSNI risk.
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Authors Christopher R. Orear, Omer Mei-Dan, Jack T. Strotbeck, Jessica Lee, Erel Ben-Ari, Tigran Garabekyan
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.501
URL
https://doi.org/10.1093/jhps/hnag043.501
Keywords Keywords not found

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