Contoured iliac crest allograft interposition for pericapsular acetabuloplasty in developmental dislocation of the hip: Technique and short-term results

Abstract

Background Pericapsular acetabuloplasty procedures have been widely used as an integral component of combined surgery to treat developmental hip dislocation after walking age. The stability of the acetabuloplasty and the maintenance of the acetabular correction will depend on the structural integrity of the iliac crest autograft, which, traditionally, has been inserted as the interposition material. Problems related to the use of an autograft have been encountered by various surgeons—including the authors—namely, graft displacement and resorption, which may necessitate internal fixation or result in revision surgery. To overcome autograft failure, the use of an allograft as the interposition material has been introduced by some surgeons. This study describes the radiologic results of 147 hips treated for developmental hip dislocation by means of a standard protocol of open hip reduction and pericapsular acetabuloplasty with a contoured iliac crest allograft as the interposition material. Methods This retrospective study reviewed the radiographs of 147 hips presenting with late developmental dislocation which were treated by open reduction and a concomitant pericapsular acetabuloplasty using a contoured iliac crest allograft as the interposition material. The minimum follow up period was 2 years. Measurement of the acetabular index (AI) was the main variable. The efficacy of the interposed iliac crest allograft as the main stabiliser of the acetabuloplasty was reflected by the maintenance of the corrected AI during the follow up period. Loss of acetabular correction, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection, hip redislocation and avascular necrosis (AVN) as possible complications were documented. Results The treatment protocol of a combined open reduction of the hip and pericapsular acetabuloplasty, inserting a contoured iliac crest allograft as the interposition material, resulted in concentrically reduced and stable hips in 96.6% of our cases. The redislocation rate was 3.4%. All of the allografts were completely incorporated at 6 months post-surgery with no graft-related infections. In only two hips was the acetabular correction not maintained. None of the osteotomies required internal fixation for stability, even in older children. Conclusion We believe that a contoured iliac crest allograft as the pericapsular acetabuloplasty interposition material renders excellent osteotomy stability that eliminates the need for internal fixation and—in the short-term—maintains the correction of the acetabulum achieved intra-operatively.

Use of iliac crest allograft for Dega pelvic osteotomy in patients with cerebral palsy

“…Most of authors used the iliac crest autograft or femoral autograft obtained from femoral shortening osteotomy as a bone graft material for Dega osteotomy and showed good clinical and radiological outcomes in patients with CP and developmental dysplasia of the hip (DDH) (Table 6 ). [ 6 , 29 – 45 ] Mallet et al investigated the long-term results after one-stage hip reconstructive surgery in children with CP. [ 37 ] They found that correction of AI remained stable postoperatively for 9 years of follow-up.…”

“…Wade et al investigated the radiologic results of 147 hips treated for DDH by Dega osteotomy with an iliac crest allograft. [ 6 ] They showed that postoperative corrected AI had improved at 2 years of follow-up. McCarthy et al compared the results of autograft and allograft in 36 hips after Pemberton osteotomy.…”

“…Wade et al showed that all of the allografts were completely incorporated at 6 months after surgery with a mean incorporation time of 3 months in 147 hips treated for DDH by Dega osteotomy. [ 6 ] Lee et al investigated the incidence and risk factors of allograft failure after lateral column lengthening for planovalgus foot deformity. [ 19 ] They reported that the mean estimated Goldberg score was 6 at 6 months after surgery and 4% of feet had Goldberg score < 6 at 6 months after surgery.…”

“…The stability and the maintenance of osteotomy are dependent on the strength of the graft materials. [ 6 ] However, patients with CP have the osteoporotic features around the hip joint. [ 7 ] When an autogenous bone graft from the iliac crest is used, it may cause growth disturbances in the iliac bone due to splitting of the iliac apophysis, longer operation time, and increased blood loss.…”

Revision of Outcomes and Complications Following Open Reduction, and Zigzag Osteotomy Combined with Fibular Allograft for Developmental Dysplasia of the Hip in Children

“…2001 [5] with the height of the graft can be increased by utilizing freeze-dried fibular allograft cut into trapezoidal sections in Dega osteotomy. Wade 2010 [24], used iliac crest allograft interposition for pericapsular acetabuloplasty in developmental dislocation of the hip. In this study, we used single fibular allograft only.…”