Retrospective analysis of the radiographic indicators for peri-acetabular osteotomy of developmental dysplasia in children

Abstract

Purpose Open surgery, nonsurgical positioning device and casting are mainstay treatments of developmental dysplasia of the hip (DDH). The optimal indicators for surgical interventions remain unclear. In this study, we aim to establish empirical, sensitive radiographic indicators for periacetabular osteotomy intervention in developmental dysplasia in Chinese children. Methods One hundred and three DDH patients treated in The Soochow University Children's Hospital between 2006 and 2012 were assessed; patients with known causes of neuron muscular and abnormal hip joint origin were excluded. Fifty-four suitable patients, demonstrating 71 dysplasia hips with complete clinical record and adequate X-ray films, were enrolled in this study. Patients were divided into group A (conservative interventions failed, followed by salvage periacetabular osteotomy) and group B (conservative treatment only); a total of 16 quantitative parameters were measured on each pelvic X-ray film. Results Among 71 hip joints measured, 29 hips of group A underwent salvage peri-acetabular osteotomy (40.8 %,) showed higher X2, Y, h, and Smith c/b (Vh) (p<0.05). The age, c, HT, b, A2 in the group A salvage operation were statistically significantly different compared to group B patients (without salvage operations) (p<0.05). Conclusions Pre-operative pelvic X-ray film assessment of acetabulum lateralization markers (X2, c, HT, c/b ratio) and the superior migration measurements (Y, h, h/b ratio) are potentially valuable radiographic indicators for determining which DDH patients will require peri-acetabular osteotomy.

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

“…If DDH is untreated or inadequately treated, it aggravates the deformity of the hip joint, which eventually develops into a nonfunctional joint with pain symptoms[ 77 ]. At that time, the change in the bony structure of the hip joint is more serious, the shaping ability of the bone decreases, the shape of the femoral head and acetabulum are difficult to reduce by simple methods, and in severe cases, cartilage injury of the hip joint occurs[ 78 ]. At that time, surgeons should pay attention to recovery of hip joint function and perform salvage surgery, so as to delay the progress of arthritis and reduce the probability of osteonecrosis of the femoral head.…”

“…The Chiari procedure cuts the ilium from front to back from the area between the acetabulum and the anterior inferior iliac spine along the ischial notch, and then the bone mass of the distal end of the ilium is moved inward and upward. In this process, it is necessary to ensure the coverage of the acetabulum to the femoral head and avoid the impact between the femoral head and ilium[ 51 , 78 ].The coverage of the acetabulum depends on the width of the ilium. In order to achieve satisfactory coverage of the lateral acetabulum, it is usually necessary to move the distal bone completely inward to the width of the ilium.…”