Eccentric Rotational Acetabular Osteotomy for Acetabular Dysplasia

Hasegawa, Yukiharu; Iwase, Toshiki; Kitamura, Shinji; Yamauchi, Kazuyo; Sakano, Shinji; Iwata, Hiroji

doi:10.2106/00004623-200203000-00011

Cited by 86 publications

(8 citation statements)

References 20 publications

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“…While in children the correction can be achieved over a rather small incision with Salter’s or Pemberton’s osteotomy, it becomes more demanding when treating adolescents and adults. For this age group several approaches to restore a physiological acetabular orientation have been described [ 1 , 2 ]. The triple osteotomy of Tönnis and the periacetabular osteotomy (PAO) of Ganz are best known and commonly used procedures [ 1 , 3 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Modification of Periacetabular Osteotomy Using a Two-Incision Approach

Bernstein¹,

Thielemann²,

Günther³

2007

TOORTHJ

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Abstract:In residual hip dysplasia periacetabular osteotomy (PAO) can improve insufficient coverage of the femoral head. It requires a broad dissection of the pelvic bones and detachment of muscle insertions, however. We have developed a modification of the Bernese periacetabular osteotomy with reduced soft tissue exposure. It uses two small skin incisions and offers therefore the perspective of nicer scars but also increases the risk of technical complications due to impaired vision. To be able to draft these risks, the clinical and radiographic results of 23 patients with PAO through the modified Smith-Petersen approach of Ganz (group A) and 24 patients with our two-incision modification (group B) have been reviewed retrospectively with an average follow-up of 19 (group A) and 12 (group B) months postoperatively.Functional improvement (Harris Hip Score) and center-edge-angle normalization did not differ significantly in both groups. Scars of patients in group B were significantly shorter. However, the overall patient satisfaction (as measured with a visual analogous scale) was the same in both groups. 4 patients in group A and one patient in group B developed superficial or deep wound infections.In conclusion, the experience with our cohort study showed that approach-related morbidity can be reduced without increasing the risk for the individual patient. This observation clearly holds a promise for further minimal invasive approaches as well as for further morbidity reduction of PAO.Level of Evidence: Retrospective comparative study (Level III).

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Section: Introductionmentioning

confidence: 99%

A Modification of Periacetabular Osteotomy Using a Two-Incision Approach

Bernstein¹,

Thielemann²,

Günther³

2007

TOORTHJ

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“…9 (2) 8 (2) 10 (3) 8 (2) 6 (4) 7 (4) T z (mm) 56 (4) 55 (4) 54 (7) 53 (6) 54 (6) 54 (6) r (mm) 22 (1) 23 (1) 22 (2) 23 (2) 23 (2) 23 ( acetabulum, excision of the quadrilateral surface of the pelvis, osteotomy of the tear drop including the quadrilateral surface, and eccentric osteotomy in rotational acetabular osteotomy (Hasegawa et al 2002).…”

Section: Discussionmentioning

confidence: 99%

Modified pubic osteotomy for medialization of the femoral head in periacetabular osteotomy: A retrospective study of 144 hips

et al. 2008

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Background and purpose Medial displacement of the femoral head reduces the force transmitted across the hip joint. Since 2005, we have performed a modified Ganz's osteotomy with curved periacetabular osteotomy (CPO) to obtain medialization of the femoral head. The modification involves cutting of the pubis at 30 degrees to the horizontal line. Here, we examined whether this modified CPO procedure medialized the femoral head more than the conventional CPO procedure.Patients and methods 69 patients (mean age 37 years, 72 hips) treated with the modified CPO procedure (the M group) were compared with 68 patients (mean age 38 years, 72 hips) previously treated with conventional CPO (the C group). All patients were operated because of dysplastic hips. We used radiographic measurements from anteroposterior radiographs. The magnitude of the resultant hip force normalized with respect to the body weight (R/WB) and hip contact joint stress (Pmax/ WB) was calculated in all cases.Results The average lateral center-edge (CE) angle, acetabular roof obliquity (ARO), and acetabulum-head index (AHI) improved in both groups. The CE angle, ARO, and AHI were similar in the 2 groups before and after surgery. Medialization of the femoral head was larger in the M group than in the C group (p < 0.001). The average value of the resultant hip force decreased from 3.2 to 2.9 in the M group and remained unchanged, at 3.1, in the C group. In addition, the average value of the peak contact stress decreased more in the M group (from 9.4 kPa/N to 3.4 kPa/N) than in the C group (from 9.1 kPa/N to 4.3 kPa/N).

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“…Pelvic osteotomy is the treatment of choice to provide more lateral and anterior coverage of the femoral head; many osteotomies have been designed for this purpose [1,[6][7][8][9][10][11][12][13]. The curved periacetabular osteotomy is one such procedure requiring an outward osteotomy from the quadrilateral surface.…”

Section: Discussionmentioning

confidence: 99%