Restrepo, Diego J

Abstract Introduction Periacetabular osteotomy (PAO) is a well-established procedure for hip preservation, traditionally performed on conventional radiolucent tables that provide rigid support to the lower extremity. The Pivot Guardian™ Distraction System extension was recently introduced to facilitate concomitant hip arthroscopy and PAO, enhancing surgical efficiency. However, flexible leg support may alter the biomechanical stability of the pelvis during osteotomy cuts, particularly the ischial osteotomy. This study compared intraoperative and perioperative outcomes of PAOs performed with the Guardian Table extension to those performed on conventional radiolucent tables. Methods All PAOs performed by one surgeon since the introduction of the guardian extension were reviewed. Seventy-two PAO cases were identified; 26 were performed on a Guardian table concomitantly with arthroscopic procedures, while 46 were performed on a conventional radiolucent Demographic variables, surgical characteristics, intraoperative complications and perioperative outcomes were compared between the groups. Groups were comparable in age, BMI, smoking status, history of previous hip arthroscopy, and primary diagnoses. Results The use of the Guardian extension had a higher proportion of women (96.2% vs. 73.9%, p=0.018) and longer operative times due to the addition of the hip arthroscopy (170 ± 54 vs. 90 ± 18 min, p < 0.0001). Notably, intraoperative posterior column fractures only occurred with the use of the Guardian table (15.4% vs. 0%, p=0.0062). No other identifiable risk factors contributed to this finding. Fractures were diagnosed based on intraoperative fluoroscopic images, or immediate postop X-rays, or X-rays at the first follow up. Rates of other complications were similar between the two groups. Conclusion While the Guardian Table extension facilitates simultaneous arthroscopic procedures in the context of PAO procedures, its use was associated with an increased risk of intraoperative posterior column fractures. This may be due to the flexible structure of the leg extension component. Surgeons should be aware of the flexible nature of the table and plan for intraoperative stabilization of the distal portion to increase rigidity.