Pemberton Osteotomy for Acetabular Dysplasia

Huang, Sheau‐Ling; Wang, Ting‐Ming; Wu, Kuan‐Wen; Fang, Chien-feng; Kuo, Ken N.

doi:10.2106/jbjs.st.k.00003

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…Reshaping osteotomies such as the Pemberton pericapsular osteotomy rely on an open triradiate cartilage hinge and alter the shape of the acetabulum to better cover the femoral head. Specifically, the Pemberton osteotomy uses an incomplete cut through the ilium extending through both the medial and lateral tables of the ilium, and hinges on the posterior limb of the triradiate cartilage to provide increased anterior and lateral coverage 4,5 (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

Badrinath

Bomar

Wenger

et al. 2019

Journal of Children's Orthopaedics

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Purpose Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH. Methods We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria. Results Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458). Conclusion The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient’s specific acetabular deficiency Level of evidence Level III retrospective comparison

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Section: Introductionmentioning

confidence: 99%

Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

Badrinath

Bomar

Wenger

et al. 2019

Journal of Children's Orthopaedics

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“…PA was performed through the standard approach and technique. [6] When performing the osteotomy and spreading the distal fragment, caution was taken to avoid overextending the osteotomy or overspreading the distal fragment to maintain the normal recoil. The graft was harvested from the iliac crest above the level of the osteotomy.…”

Section: Methodsmentioning

confidence: 99%

Pemberton’s acetabuloplasty without cast application for the treatment of acetabular dysplasia in older children: A case series

Kremli¹,

Ismael²,

Mohaini

et al. 2022

JMSR

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Objectives: To study the safety and efficacy of performing Pemberton’s acetabuloplasty (PA) in older children without application of post-operative cast to avoid the restriction and complications of cast in older children. Methods: Patients who had acetabular dysplasia and underwent Pemberton’s acetabuloplasty without cast during the period 1999-2021 were selected for the study. Cases were followed until radiographic healing of the osteotomy. Results: Twenty patients (22 hips) were included in the study. Primary acetabular dysplasia was recently discovered because of pain in 10 patients; the other 10 had residual acetabular dysplasia after treatment of developmental hip dysplasia (DDH). Most patients (19 hips in 18 patients) had a PA without internal fixation and post-operative cast. Two patients had an internal fixation with a cannulated screw because of concern about compliance with non/toe-touch weight-bearing post-operatively. The mean age on the time of surgery was 10.4 years (6.5–15.5 years). The mean body weight on the day of surgery was 42.8 Kg. (30-66 Kg.). The mean postoperative follow-up was 38 months (three months – 14 years). All patients were able to walk using a walker within five days after surgery. The follow-up radiographs showed no graft collapse and no displacement of the graft or osteotomy. Correction of the acetabular dysplasia and corrected Shenton’s line were confirmed on the last follow-up with no re-dislocation or re-subluxation of the hip. Conclusion: Performing Pemberton’s acetabuloplsty in older children without application of post-opertaive cast is efficient and safe. Complications of cast and the gross limitation it has on daily living activities and mobilization are all avoided without compromising the surgical results and healing. Care should be taken to ensure that patients and caregivers clearly understand the importance of non/toe-touch weight-bearing post-operatively and are compliant.

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“…We retrospectively reviewed the medical records of all consecutive DDH patients who had undergone either guided growth or varus osteotomy for treatment of valgus deformity due to Kalamchi type II AVN of the proximal femur, from September 2009 to January 2019 at our hospital. Patients included were those who had undergone a single-stage open reduction and Pemberton acetabuloplasty for DDH, 16 and had a minimum follow-up of two years. Those patients who had hip conditions associated with neuromuscular diseases or congenital anomalies were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Guided growth versus varus osteotomy for type II avascular necrosis following surgery for developmental dysplasia of the hip

Hsu

Lee

Lin

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to compare outcomes of guided growth and varus osteotomy in treating Kalamchi type II avascular necrosis (AVN) after open reduction and Pemberton acetabuloplasty for developmental dysplasia of the hip (DDH). Methods This retrospective study reviewed patients undergoing guided growth or varus osteotomy for Kalamchi type II AVN between September 2009 and January 2019. All children who had undergone open reduction and Pemberton acetabuloplasty for DDH with a minimum two-year follow-up were enrolled in the study. Demographic and radiological data, which included the head-shaft angle (HSA), neck-shaft angle (NSA), articulotrochanteric distance (ATD), Sharp angle (SA), and lateral centre-edge angle (LCEA) at baseline, two years, and at the extended follow-up, were compared. Revision rates were evaluated. Clinical outcomes using the Harris Hip Score were assessed two years postoperatively. Results A total of 24 patients underwent guided growth and 19 underwent varus osteotomy, over a mean period of 3.3 years (95% confidence interval (CI) 2.8 to 3.8) and 5.2 years (95% CI 4.5 to 6.0), respectively. There were no differences in demographic and preoperative radiological data, except for a younger age at time of acetabuloplasty and larger ATD for the osteotomy group. The HSA did not differ at two years and the extended follow-up because of postoperative rebound in the osteotomy group. The NSA of the osteotomy group remained smaller postoperatively. There were no significant differences in the follow-up ATD, SA, and LCEA, except for a smaller two-year ATD of the osteotomy group. Seven patients (29.2%) in the guided growth group underwent revision surgery and none in the osteotomy group. The Harris Hip Score was similar between groups. Conclusion Guided growth and varus osteotomy had comparable results in improving caput valgum deformity, given the rebound of lateral tilting of the physis after osteotomy correction. There were no differences in clinical outcomes at two years postoperatively. Cite this article: Bone Joint J 2022;104-B(7):902–908.

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Pemberton Osteotomy for Acetabular Dysplasia

Cited by 12 publications

References 12 publications

Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

Pemberton’s acetabuloplasty without cast application for the treatment of acetabular dysplasia in older children: A case series

Guided growth versus varus osteotomy for type II avascular necrosis following surgery for developmental dysplasia of the hip

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