Early weight-bearing after periacetabular osteotomy leads to a high incidence of postoperative pelvic fractures

BMC Musculoskeletal Disorders

Takeo Matsuno¹  Yasuhiro Nishida¹  Tatsuya Sato¹  Hiromasa Tanino¹  Hiroshi Ito¹ 

[1] Department of Orthopaedic Surgery, Asahikawa Medical University, Higashi 2-1-1-1, Midorigaoka, 078-8510 Asahikawa, Japan

关键词: Complications;    Accelerated rehabilitation protocol;    Periacetabular osteotomy;   

Others  :  848317
DOI  :  10.1186/1471-2474-15-234

 received in 2014-03-01, accepted in 2014-07-08,  发布年份 2014

【 摘 要 】

Background

It has not been shown whether accelerated rehabilitation following periacetabular osteotomy (PAO) is effective for early recovery. The purpose of this retrospective study was to compare complication rates in patients with standard and accelerated rehabilitation protocols who underwent PAO.

Methods

Between January 2002 and August 2011, patients with a lateral center-edge (CE) angle of < 20°, showing good joint congruency with the hip in abduction, pre- or early stage of osteoarthritis, and age younger than 60 years were included in this study. We evaluated 156 hips in 138 patients, with a mean age at the time of surgery of 30 years. Full weight-bearing with two crutches started 2 months postoperatively in 73 patients (80 hips) with the standard rehabilitation protocol. In 65 patients (76 hips) with the accelerated rehabilitation protocol, postoperative strengthening of the hip, thigh and core musculature was begun on the day of surgery as tolerated. The exercise program included active hip range of motion, and gentle isometric hamstring and quadriceps muscle sets; these exercises were performed for 30 minutes in the morning and 30 minutes in the afternoon with a physical therapist every weekday for 6 weeks. Full weight-bearing with two axillary crutches started on the day of surgery as tolerated. Complications were evaluated for 2 years.

Results

The clinical results at the time of follow-up were similar in the two groups. The average periods between the osteotomy and full-weight-bearing walking without support were 4.2 months and 6.9 months in patients with the accelerated and standard rehabilitation protocols (P < 0.001), indicating that the accelerated rehabilitation protocol could achieve earlier recovery of patients. However, postoperative fractures of the ischial ramus and posterior column of the pelvis were more frequently found in patients with the accelerated rehabilitation protocol (8/76) than in those with the standard rehabilitation protocol (1/80) (P = 0.013).

Conclusion

The accelerated rehabilitation protocol seems to have advantages for early muscle recovery in patients undergoing PAO; however, postoperative pelvic fracture rates were unacceptably high in patients with this protocol.

【 授权许可】

   
2014 Ito et al.; licensee BioMed Central Ltd.

【 图 表 】

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