Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities

Ganz, Reinhold; Horowitz, Kevin; Leunig, Michael

doi:10.1007/s11999-010-1489-z

Cited by 136 publications

(131 citation statements)

References 27 publications

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“…Surgical hip dislocation with development of an extended retinacular soft tissue flap gives safe access to the femoral head and enables intracapital osteotomies. However, only limited information of clinical and radiographic outcome after femoral head reduction osteotomy has been reported [3,11,16]. We therefore asked whether femoral head reduction osteotomy in hips with severe asphericity of the femoral head results in (1) improved head sphericity and containment; (2) pain Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…However, asphericities in the frontal plane cannot be addressed by resection because of the risk of damage to nutrient retinacular vessels of the femoral head. Improved understanding of the vascular supply of the femoral head led to the development of head reduction osteotomy [3,4], a procedure that allows for downsizing and reshaping the femoral head to improve head sphericity, containment, and potentially improve function and decrease hip pain [11].…”

Section: Introductionmentioning

confidence: 99%

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Head Reduction Osteotomy With Additional Containment Surgery Improves Sphericity and Containment and Reduces Pain in Legg-Calvé-Perthes Disease

Siebenrock

Anwander

Zurmühle

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Severe femoral head deformities in the frontal plane such as hips with Legg-Calvé-Perthes disease (LCPD) are not contained by the acetabulum and result in hinged abduction and impingement. These rare deformities cannot be addressed by resection, which would endanger head vascularity. Femoral head reduction osteotomy allows for reshaping of the femoral head with the goal of improving head sphericity, containment, and hip function. Questions/purposes Among hips with severe asphericity of the femoral head, does femoral head reduction osteotomy result in (1) improved head sphericity and containment; (2) pain relief and improved hip function; and (3) subsequent reoperations or complications? Methods Over a 10-year period, we performed femoral head reduction osteotomies in 11 patients (11 hips) with severe head asphericities resulting from LCPD (10 hips) or disturbance of epiphyseal perfusion after conservative treatment of developmental dysplasia (one hip). Five of 11 hips had concomitant acetabular containment surgery including two triple osteotomies, two periacetabular osteotomies (PAOs), and one Colonna procedure. Patients were reviewed at a mean of 5 years (range, 1-10 years), and none was lost to followup. Mean patient age at the time of head reduction osteotomy was 13 years (range, 7-23 years). We obtained the sphericity index (defined as the ratio of the minor to the major axis of the ellipse drawn to best fit the femoral head articular surface on conventional anteroposterior pelvic radiographs) to assess head sphericity. Containment was assessed evaluating the proportion of patients with an intact Shenton's line, the extrusion index, and the lateral center-edge (LCE) angle. Merle d'Aubigné-Postel score and range of motion (flexion, internal/external rotation in 90°of flexion) were assessed to measure pain and function. Complications and reoperations were identified by chart review. Results At latest followup, femoral head sphericity (72%; range, 64%-81% preoperatively versus 85%; range, 73%-96% postoperatively; p = 0.004), extrusion index (47%; range, 25%-60% versus 20%; range, 3%-58%; p = 0.006), and LCE angle (1°; range, À10°to 16°versus 26°; range, 4°-40°; p = 0.0064) were improved compared with preoperatively. With the limited number of hips available, the proportion of an intact Shenton's line (64% versus 100%; p = 0.087) and the overall Merle d'Aubigné-Postel score (14.5; range, 12-16 versus 15.7; range, 12-18;

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Head Reduction Osteotomy With Additional Containment Surgery Improves Sphericity and Containment and Reduces Pain in Legg-Calvé-Perthes Disease

Siebenrock

Anwander

Zurmühle

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Despite good results published in the past [22][23][24][25], shelf operation is currently used mainly as a salvage procedure [9,21]. According to some authors, its main disadvantage is considered the fact that the bone graft does not ensure an adequate articulation for the femoral head cartilage [14].…”

Section: Discussionmentioning

confidence: 99%

“…In the 1970s, new coverage procedures were described, i.e. pelvic and acetabular osteotomies, which are currently preferred [5][6][7][8][9]. Despite a number of positive references [10][11][12][13][14][15], shelf arthroplasty is considered to be merely a salvage procedure [9].…”

Section: Introductionmentioning

confidence: 99%

Bosworth hip shelf arthroplasty in adult dysplastic hips: ten to twenty three year results

Bartoníček

Vávra

Chochola

2012

International Orthopaedics (SICOT)

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Purpose Hip shelf arthroplasty is currently considered to be a salvage procedure. The aim of the study is to present outcomes of Bosworth hip shelf arthroplasty in adolescent dysplastic hips with a minimum ten-year follow-up. Methods The basic group comprised 25 hips in 18 patients with the mean age of 31 years (range, 16-52) at the time of operation. Subgroup A included 20 hips that were evaluated prior to operation as spherical, centric hips without osteoarthritic changes (acetabular dysplasia). The heterogeneous subgroup B comprised five hips. Of these, three hips were evaluated as aspheric, without osteoarthritic changes, and two hips as aspheric, with osteoarthritic changes of grade 2 according to Tönnis. In addition, two hips in subgroup B were evaluated as decentred (subluxated), one hip without and one hip with osteoarthritic changes. The mean follow-up was 15 years (range, ten-23). Results In subgroup A, the positive effect of operation had lasted at the time of the final follow-up for ten to 22 years postoperatively (average follow-up 14 years) in 19 hips. Only one female patient, 46 years old at the time of operation, developed hip osteoarthritis within ten years, that was treated by THA. In subgroup B, a lasting positive effect of operation was recorded in two cases at the time of the final follow-up (12 and 15 years). The third female patient with an aspheric and decentred hip developed severe hip osteoarthritis 21 years after shelf procedure that was treated by THA. In two patients who had hip osteoarthritis already before the operation, the positive effect of the shelf procedure survived over 13 and 20 years. Although hip osteoarthritis progressed, THA was performed as late as 15 and 23 years after the shelf procedure. The mean Harris hip score in 21 hips with a still functional hip shelf was 68 (range, 56-82) before and 90 (range, 76-100) after the surgery. Conclusion The best outcomes of Bosworth hip shelf arthroplasty may be expected in a dysplastic spherical centred hip without osteoarthritic changes. In the presence of asphericity, decentration and osteoarthritic changes, neither the effect of the surgery nor its survival can be clearly predicted.

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“…Ganz et al [70] have shown that their surgical approach for hip dislocation and osteochondroplasty can be applied to hips affected by LCPD, allowing full inspection and dynamic assessment of the femoroacetabular contact during hip motion.…”

Section: Lcpdmentioning

confidence: 99%