Minimally invasive (MIS) Tönnis osteotomy– A technical annotation and review of short term results

Balachandran, Balakumar; Racy, Malek; Madan, Sanjeev

doi:10.1016/j.jor.2018.01.043

Cited by 8 publications

(13 citation statements)

References 14 publications

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“…For the osteotomy position, it is suggested that the osteotomy should be placed as far proximally as possible on the ischial spine to minimize the effect of the rotation angle of the osteotomy site because of the limitation by the sacrospinous ligament. 15 In the present study, we did not perform intraoperative fluoroscopic localization of the osteotomy position of the ischium in all cases. The osteotomy chisel was placed close to the capsule, and the ischium was osteotomized obliquely toward the contralateral ASIS without detaching the sacrospinous ligament origin.…”

Section: Discussionmentioning

confidence: 84%

Novel Minimally-Invasive Triple Pelvic Osteotomy: JiShuiTan Minimally-Invasive Approach

Lyu

Yang

Wang

et al. 2021

Journal of Pediatric Orthopaedics

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Purpose: Triple pelvic osteotomy (TPO) is often performed to improve femoral head coverage, correct deformity, and stabilize the hip joint in a variety of pediatric orthopaedic conditions. After the TPO was first reported, many modifications were developed to simplify or improve the procedure, however, because of the specific anatomy with several critical nerves and vessels passing through the approaches, extensive exposure and prolonged intraoperative fluoroscopy are often required for TPO. This report introduces a novel, minimally-invasive surgical approach that minimizes the time of intraoperative fluoroscopy and size of the surgical incision, and reviews our experience. Methods: A total of 48 hips in 43 patients with a mean age of 8.3 ± 1.7 years (range: 6.0 to 12.2 y) were included in this study. Of these, 21 patients (22 hips) had Legg-Calvé-Perthes disease (LCPD) and 22 patients (26 hips) had developmental dysplasia of the hip (DDH). The TPOs were performed using the novel, minimally-invasive TPO approach, with a mean postoperative follow-up of 38 months (range: 24 to 54 mo) in the DDH group and 44 months (range: 23 to 58 mo) in the LCPD group. The acetabular index (AI), femoral head migration rate (MP), center edge angle (CEA) and the Severin and Stulberg classification systems were used to evaluate the preoperative and postoperative results. SPSS software was used to analyze the data. Results: The AI decreased from 33.8 degrees ± 9.2 to 2.9 degrees ± 10.1, the lateral CEA increased from −10.8 degrees ± 23.8 to 34.1 degrees ± 9.9, and the femoral head MP decreased from 64.0% ± 19.8% to 1.1% ± 2.6% in the DDH group at last followup, indicating significant improvement. The AI decreased from 20.8 degrees ± 4.7 to −1.3 degrees ± 7.3, the lateral CEA increased from 6.8 degrees ± 11.5 to 42.3 degrees ± 6.4, and the femoral head MP decreased from 42.2% ± 13.0% to 1.3% ± 3.3% in the LCPD group at last follow-up, also indicating significant improvement. Conclusion: This approach can simplify the TPO, making the complex operation safer, more effective, and capable of achieving satisfactory correction.

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Section: Discussionmentioning

confidence: 84%

Novel Minimally-Invasive Triple Pelvic Osteotomy: JiShuiTan Minimally-Invasive Approach

Lyu

Yang

Wang

et al. 2021

Journal of Pediatric Orthopaedics

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“…Joseph (1989) and Huhnstock et al (2014a, 2014b) ascertained that the affected side of children diagnosed with Legg‐Calve‐Perthes disease had higher angle values from the unaffected side; Torode and Young (2015) and Balakumar et al (2018) reported that SA significantly decreased from the preoperative to the postoperative period in those planned to undergo TPF (Transphyseal Screw Fixation) and osteotomy surgery. Abousamra et al (2016) reported that mean SA measurements of children with cerebral palsy were 53° in the preoperative period and 44° in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Morphometric assessment of the hip joint in children aged 2–13 years

2023

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Our study aimed to evaluate the hip joints of healthy children aged 2–13 years morphometrically through radiographic images. Demographic characteristics of 300 healthy children in our study include an average age of 6.4 years old based on the 2‐to‐13‐year‐old bracket and sex classified to 133 girls and 167 boys. A total of 600 normal hips from these children were digitally measured based on Acetabular Index, ACM angle, MZ distance, Sharp angle, CE angle, Femoral Head Coverage Ratio, Cranial, and medial joint space (MJS). *p < 0.05; **p < 0.01 indicated a statistically significant difference. It was found that Acetabular Index, ACM angle, MZ distance, Sharp angle, Cranial, and MJSs decreased with age; Acetabular Depth value and CE angle increased with age; the CE angle differed between the sides (right–left) in the young teens period and in boys; and the cranial joint space (CJS) differed between the sides in girls. In addition, girls had higher values than boys in terms of Acetabular Index, ACM angle, Sharp angle, MZ distance, and Femoral Head Coverage Ratio; CE angle and MJS were higher in girls; and Acetabular Depth Value and CJS did not differ significantly between sexes. Obtaining the normal values will guide in the diagnosis and treatment of many clinical conditions including DDH and Legg‐Calve‐Perthes disease. It can also be used to compare the hips between healthy children and those diagnosed with Cerebral Palsy.

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“…С тех пор эта хирургическая методика получила многочисленные модификации, которые в первую очередь касаются количества доступов к костям таза [14,15,16,17]. На сегодняшний день все чаще появляются публикации об использовании малоинвазивных хирургических методов для выполнения тройной остеотомии таза [18,19,20,21].…”

Section: таблица 3 значения основных рентгенометрических параметров х...unclassified

“…Так, B. Balakumar с соавторами описывают выполнение тройной остеотомии таза из доступа типа «бикини» с длиной разреза 5-7 см, а W.B. Lehman с соавторами и вовсе выполняют данную операцию из двух «практически чрескожных» косметических доступов [18,19]. Одновременно с этим необходимо отметить, что об эффективности тройной остеотомии таза, выполненной из малоинвазивных доступов, судят лишь по степени достигнутой коррекции и протяженности разреза кожи.…”

Section: таблица 3 значения основных рентгенометрических параметров х...unclassified

“…Для осуществления остеотомий костей таза и реориентации вертлужной впадины ортопедами используется от одного до трех хирургических доступов [14,15,16,17]. Кроме того, имеются работы, посвященные выполнению тройной остеотомии из малоинвазивных доступов [18,19,20,21]. Однако необходимо отметить, что на сегодняшний день существуют противоречия в понятии «малоинвазивный доступ».…”

Section: Introductionunclassified

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Surgical Approaches for Triple Pelvic Osteotomy in Children With Hip Dysplastic Instability: Assessment of Muscle Damage

Bortulev

Baskaeva

Barsukov

et al. 2022

Traumatology and Orthopedics of Russia

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Aim - on the basis of clinical and laboratory data, to analyze the degree of muscle injury during triple pelvic osteotomy with various approaches in patients with hip dysplasia Matherials and methods. The study included 70 patients aged 12 to 18 years with dysplasia Crowe I grade treated between 2020 and 2021. All children were divided into two groups - I - 35 patients who underwent triple pelvic osteotomy from an anterolateral approach, group II - 35 patients who underwent triple pelvic osteotomy from two approaches (medial and bikini"). In addition to standard radiometry of hip joints, such indicators as the severity of pain syndrome on the VAS scale were evaluated, as well as biochemical analysis of markers of muscle injury (LDH, CPK, creatinine, AST, C-reactive protein) before surgery and on the 3rd and 7th days after surgery. Results. The intensity of the pain syndrome according to the questionnaire data was more pronounced (p0.05) in patients who underwent surgery from an anterolateral access, and the values of CPK and C-reactive protein significantly (p0.05) exceeded those in patients who underwent triple pelvic osteotomy from two surgical approaches. The data obtained indicate greater surgical aggression against the muscles of the hip joint area during the anterolateral approch for triple pelvic osteotomy. Conslusion. A comparative analysis of the traumaticity of surgical approaches during triple pelvic osteotomy in children with hip dysplasia Crowe I degree, based on the assessment of biochemical indicators of markers of muscle injury and the intensity of pain syndrome in the postoperative period showed that the use of anteriorlateral approach significantly (p0.05) has a greater injury to muscle tissue than the use of two surgical accesses (medial and bikini), as evidenced by significant increases in CPK and CRP in the blood, as well as a more pronounced pain syndrome in the immediate postoperative period.

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Minimally invasive (MIS) Tönnis osteotomy– A technical annotation and review of short term results

Abstract: We have described a minimally invasive Tonnis osteotomy as a viable option based on our results. This technique is recommended for those who are conversant with the traditional pelvicosteotomies.

Cited by 8 publications

References 14 publications

Novel Minimally-Invasive Triple Pelvic Osteotomy: JiShuiTan Minimally-Invasive Approach

Novel Minimally-Invasive Triple Pelvic Osteotomy: JiShuiTan Minimally-Invasive Approach

Morphometric assessment of the hip joint in children aged 2–13 years

Surgical Approaches for Triple Pelvic Osteotomy in Children With Hip Dysplastic Instability: Assessment of Muscle Damage

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