Rotational acetabular osteotomy for severe dysplasia of the hip with a false acetabulum

Abstract

We have divided Severin group-V severely dysplastic hips with a false acetabulum into three subtypes, based on the height and shape of the socket. We performed rotational acetabular osteotomy (RAO) in 19 hips in 17 young adults with a type-1 'low' false acetabulum which had direct contact with the true acetabulum. This is a periacetabular osteotomy which gives acetabular coverage with articular cartilage and produces a nearly normal position of the head. Concomitant osteotomies of the proximal femur were carried out in 11 hips. We reviewed the patients clinically and radiologically at a mean of ten years (6 to 18) after operation. Of the 19 hips, 15 showed very good or good results. This operation is indicated in young adults with a dysplastic hip and a type-1 low false acetabulum. Subclassification of Severin group V is a convenient way of defining those patients who would benefit from the procedure.

Peri-acetabular rotational osteotomy with concomitant hip arthroscopy for treatment of hip dysplasia

“…Similarly the mean head lateralisation index decreased from 82.6 to 72.3 in a series of rotational acetabular osteotomy without arthrotomy. 27 In another series of 46 hips undergoing T-shaped capsulotomy at a mean follow-up of 4.2 years, the mean centre-edge angle improved from 3° to 35°, the mean Sharp angle from 57° to 40° and the mean medialisation of the femoral head was 6 mm. 35 In our series, at the most recent follow-up, the severity of osteoarthritis had improved in eight (18.6%) and remained unchanged in 31 (72.1%) and other radiological parameters had improved significantly.…”

“…23 Group A included 30 hips (including two bilateral patients) with pre-arthritis or early arthritis (Tönnis grade 0 and I) and group B 13 hips (including one bilateral patient) with advanced arthritis (Tönnis grade II and III). 23 Radiological evaluation included measurement of the centre-edge angle, 24 Sharp angle, 25 acetabular-head index 26 and head lateralisation index; 27 and was undertaken pre-operatively and during post-operative follow-up. The clinical outcome was evaluated using the Harris hip score 28 (HHS) which was recorded pre-operatively and at each post-operative visit.…”

Periacetabular Osteotomy in the Treatment of Severe Acetabular Dysplasia

“…Others have reported that rotational acetabular osteotomy is an effective surgical option for the management of a severely dysplastic hip 3,29 . With this technique, the acetabulum is fashioned into a hemispherical shape with an osteotomy, starting at the external region of the joint capsule, and the acetabulum is rotated en bloc anterolaterally.…”

Rotational acetabular osteotomy for severely dysplastic acetabulum

“…Therefore, we should try to achieve adequate coverege of the femoral head and pay attention to the age at operation, especially when both hips are involved. Moreover, Shindo et al have reported that RAO is not indicated for patients who have marked deformity of the femoral head with an incongruent joint which cannot be adjusted by additional proximal femoral osteotomy [10]. The blood supply of the osteotomized acetabulum showed no impairment, as is the case with Ganz osteotomy.…”

“…Only these 6 hips were classified as Severin group V. Moreover, they fitted into the Shindo type 1 low false acetabulum subtype of Severin group V [10]. The age at operation ranged from 17 to 43 years (mean 33.8 years).…”