A Periacetabular Osteotomy for the Treatment of Severe Dysplastic Hips

Karashima, Hirotaka; Naito, Masatoshi; Shiramizu, Kei; Kiyama, Takahiko; Maeyama, Akira

doi:10.1007/s11999-010-1616-x

Cited by 22 publications

(18 citation statements)

References 22 publications

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“…However, lately, more and more emphasis is being laid on acetabuloplasty as a primary procedure in addition to the reduction. In a study by Karashima et al ., a periacetabular osteotomy as a primary procedure gives excellent results in severely dysplastic hips (C-E angle < 0°) and mild dysplastic hips (C-E angle 3.3-14.5°) 9. In their study including 71 patients, Spence et al .…”

Section: Discussionmentioning

confidence: 98%

Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months

Narasimhan

Patil

Mahna

2014

IJOO

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Background:Developmental dysplasia of hip (DDH) is a common condition presenting to a pediatric orthopedic surgeon. There is a consensus on the surgical treatment of children with ages ranged from 18 to 24 months where majority agree on open reduction and hip spica. Open reduction was done with an additional pelvic procedure wherever required to get better results and prevent residual acetabular dysplasia (RAD) and early osteoarthritis.Materials and Methods:35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2-7 years).Results:No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI) of 35° and above. These were all from the group where open reduction alone was done.Conclusion:We feel that a preoperative AI of >40° and a per-operative safe-zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum.

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Section: Discussionmentioning

confidence: 98%

Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months

Narasimhan

Patil

Mahna

2014

IJOO

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“…Additionally, 18 hips (75%) were defined as acetabular side deformity under the hypothetical situation of either positive cross over sign or posterior wall sign. Regarding the surgical treatment for DDH, various forms of periacetabular osteotomy have been proposed and reported with their surgical outcome [12] [20]. Al-though these procedures can effectively improve lateral coverage of the femoral head, inadvertent post-operative acetabular retroversion has also been reported [6] [10] [21].…”

Section: Discussionmentioning

confidence: 99%

Morphology of Acetabulum and Femoral Head-Neck Junction in Hip Dysplasia Which Underwent Rotational Acetabular Osteotomy

Kanto¹,

Nakayama²,

Nishio³

et al. 2015

OJO

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The purpose of this study was to evaluate the preoperative radiographs with cases of developmental dysplasia of the hip (DDH) leading to rotational acetabular osteotomy (RAO) or curved peri-acetabular osteotomy (CPO), and examine the frequency of femoroacetabular impingement (FAI) related bone morphology in the acetabulum and femoral head-neck junction. Twenty-four hips with hip dyaplasia who underwent CPO or RAO were included in this study. Six hips had grade 0 and eighteen hips had grade 1 OA according to the Tönnis classification. We excluded patients with moderate and severe hip osteoarthritis and major femoral head deformities. Preoperative radiograph was evaluated on sharp angle, center-edge angle, alpha angle, crossover sign and posterior wall sign. Crossover signs were revealed in 7 hips (29.2%); posterior wall signs were revealed in 16 hips (66.7%); and cam-type deformities with an alpha angle of ≥50.5˚ were observed in 19 hips (79.2%) in preoperative evaluation. As determined using the Tönnis scale, no progression of osteoarthritis was found in 16 of the 24 hips; there was a one-grade progression in 8 hips. Among the 8 hips, either positive cross-over sign or posterior sign in acetabulum, and an alpha angle of ≥50.5˚ in femur were observed in six hips with progression of osteoarthritis. The presence of cam-type deformity and acetabular retroversion in patients who underwent RAO or CPO was relatively high in preoperative radiographs, and caution should be employed during surgery in patients with DDH. There is a possibility of secondary FAI due to excessive forward coverage of the bone fragments after RAO and CPO. R. Kanto et al.

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“…We investigated the results of CPO alone for the treatment of severe dysplastic hips (44 hips) of Severin32) group IV-b, compared to those for moderate dysplastic hips (147 hips) of Severin group III and IV-a 33). The mean postoperative acetabular roof obliquity and head lateralization index values did not differ significantly between the two groups.…”

Section: Older Patients and Severity Of Acetabular Dysplasia For Indimentioning

confidence: 99%

Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

Naito

Nakamura

2014

Clin Orthop Surg

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Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 ± 0.57 m/sec2 preoperatively to 1.55 ± 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20° could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.

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A Periacetabular Osteotomy for the Treatment of Severe Dysplastic Hips

Abstract: Background We believe a curved periacetabular osteotomy is indicated for treatment of severe dysplastic hips with center-edge angles less than 0°,

Cited by 22 publications

References 22 publications

Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months

Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months

Morphology of Acetabulum and Femoral Head-Neck Junction in Hip Dysplasia Which Underwent Rotational Acetabular Osteotomy

Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

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