Necessarily disappointing results after trippleosteotomy in the dysplastic hip joint

Leitz, G; Reck, R

doi:10.1007/bf00389698

Cited by 22 publications

(6 citation statements)

References 2 publications

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“…We should realize that after correcting the CE angle to normal, the resulting force will not be transferred from the head of the femur to the articular (lunate) surface of the acetabulum, but to the acetabular fossa. Leitz and Reck (1979) had very poor results after triple osteotomy, despite an ideal indication. They found that the result of triple osteotomy became progressively worse the more the acetabular fossa was brought into the zone of high pressure.…”

Section: Discussionmentioning

confidence: 98%

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

Böhm¹,

Weber

2003

Acta Orthopaedica Scandinavica

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Section: Discussionmentioning

confidence: 98%

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

Böhm¹,

Weber

2003

Acta Orthopaedica Scandinavica

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“…Periacetabular osteotomies such as RAO cause considerable changes in joint morphology and increase the postoperative load on the articular cartilage, particularly in the medial part of the acetabulum. 18,19 Unless there is only prearthritis or minimal degeneration of the articular cartilage before operation, the joint may be unable to cope with the biomechanical changes and OA will progress early after surgery. 20,21 We recently described joint remodelling after this procedure.…”

Section: 16mentioning

confidence: 99%

The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy

Yasunaga

Ikuta

Kanazawa

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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We have studied whether the state of the articular cartilage at the time of rotational acetabular osteotomy for dysplasia of the hip affects the outcome 2 to 5.5 years after surgery. Arthroscopy in 57 patients (59 joints) at the time of the operation showed grade-0 changes in seven, grade-1 in nine, grade-2 in 17, grade-3 in 14 and grade-4 in 12 joints, according to the classification of Outerbridge. There was radiological evidence of the progression of arthritis in four joints which were classified at arthroscopy as grade 4.Stepwise regression analysis showed that damage to acetabular or femoral articular cartilage significantly affected the progression of arthritis. We conclude that the short-term results of successful rotational acetabular osteotomy for dysplasia are affected by the state of the articular cartilage. Periacetabular osteotomies for osteoarthritis (OA) secondary to hip dysplasia have theoretical advantages over other pelvic procedures such as the Chiari osteotomy, 1 because they alter the position of the acetabulum en bloc allowing cover of the femoral head by cartilage. 2-6 These procedures have produced satisfactory long-and medium-term results for early OA secondary to dysplasia of the hip. 6,7 When progression of the degenerative changes has been seen, the presence of preoperative OA has been cited as the cause. Arthroscopic observations of the articular cartilage in early OA of the hip, however, vary widely. 8 Our aim was to determine how the state of the articular cartilage affects the outcome of rotational acetabular osteotomy carried out for dysplasia of the hip. Patients and MethodsOf 62 patients (65 joints) who underwent rotational acetabular osteotomy (RAO) 5 between 1994 and 1998, we studied 57 (59 joints) who also had an arthroscopy during the operation. There were 55 women (57 joints) and two men (2 joints) with a mean age at the time of surgery of 37.5 years (12 to 57). OA of the hip was classified into four stages according to the radiological appearance: 1) prearthritis, no osteoarthritic change; 2) early, with slight narrowing of the joint space associated with sclerosis of the subchondral bone; 3) advanced, with narrowing of the joint space, cystic lucencies and small osteophytes; and 4) end stage, with disappearance of the joint space and marked formation of osteophytes. Ten joints had prearthritis and 35 were in the early stage and 14 in the advanced stage. The mean followup was for 3 years and 2 months (2 to 6.5 years). The indications for RAO were acetabular dysplasia, characterised radiologically by a centre-edge (CE) angle of less than 20° and pain severe enough to interfere with normal activities. 9 Patients with improvement in cover of the femoral head and joint congruency on an anteroposterior (AP) plain radiograph in abduction, were considered to be suitable for surgery. RAO was carried out using the technique of Ninomiya and Tagawa 5 with one modification in that the rotated acetabulum was fixed by two poly-L-lactic acid screws (Gunze, Kyoto, Japan) instead of Kirsc...

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“…Torn acetabular labrum · Triple pelvic osteotomy · Technique · Results Pfannennekrosen wurden an unserem Material nicht beobachtet, nur an zugewiesenen Patienten, bei denen in die Pfanne eingemeiûelt wurde und die A. und V. acetabularis verletzt sein muûten, so wie wir es den Ausführungen von Leitz u. Reck nach Hopf-Osteotomie auch entnahmen [9]. Spätere Totalprothesenimplantationen waren deshalb nur ganz vereinzelt erforderlich, entweder bei schwerer Arthrose oder überzogenen Indikationen.…”

Section: Introductionunclassified

Acetabular rotation by triple pelvic osteotomy according to Tönnis

1998

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Lesions of the acetabular labrum should be treated by correcting the causes. In a steep acetabulum where the femoral head brings the acetabular labrum under tension and traction, the acetabulum should be rotated by triple pelvic osteotomy to slightly over-corrected acetabular measurements. Severely diminished acetabular and femoral anteversion can also lead to tears and impingement of the labrum. Then rotation of the femoral neck and/or rotations of the acetabulum by triple osteotomy to 15-20 degrees of anteversion are indicated. Our triple osteotomy technique differs from that of others mainly in the ischial osteotomy. It is performed from the posterior approach between the sciatic notch next to the ischial spine and the obturator foramen and is directed 20-30 degrees anteriorly from the frontal (coronal) plane. The osteotomies therefore are placed close enough to the acetabulum to allow free rotation, but they do not interfere with the circulation of the acetabulum, and the ligaments between the sacrum and ischium are left in normal tension. Our normal values of the acetabular position were tested by correlating the measurements with the absence of pain. The optimum is reached with a CE angle and a VCA angle of 30-35 degrees, an angle of the weight-bearing zone of +5 to -5 degrees and a migration index of 10-15%. Overcorrections again caused pain and should be avoided. Diminished anteversion of femur and acetabulum towards 0 degree also caused pain and should be corrected by triple and femoral osteotomy to 15-20 degrees of anteversion. In earlier follow-ups of 216 hips 5-10 years postoperatively, 82.3% of the joints showed no change in the degree of osteoarthrosis. Survival rate curves regarding the absence of pain demonstrated that pain was experienced again when joints were corrected insufficiently or overcorrected, while in good corrections the joints were free of pain in about 75%.

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Necessarily disappointing results after trippleosteotomy in the dysplastic hip joint

Cited by 22 publications

References 2 publications

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy

Acetabular rotation by triple pelvic osteotomy according to Tönnis

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