Short Term Radiological Outcome of Combined Femoral and Ilium Osteotomy in Pelvic Reconstruction of the Child

Abstract

Background and Objectives: Reconstruction of the pelvic joint is a common way to address developmental dysplasia of the hip (DDH), as well as neurogenic dislocation of the hip (NDH) and Legg–Calvé–Perthes disease (LCPD) in children. The purpose of this study was to analyze the short-term radiologic outcome after hip reconstructive surgery either treated with sole osteotomy of the femur or in combination with iliac osteotomy in patients with DDH, NDH and LCPD. Materials and Methods: X-rays of 73 children, aged 2–18 years, with DDH, NDH and LCPD after hip reconstructive surgery were measured retrospectively and compared to the preoperative x-rays concerning various parameters to define hip geometry. The surgical procedures were femoral osteotomy (74), Salter innominate osteotomy (27), Pemberton osteotomy (27), open reduction (37), Chiari osteotomy (4). The pre-/postoperative acetabular index (AI), center-edge angle (CE) and Reimers migration index (RMI) were evaluated before and 3 months after surgery. Results: Hip geometry parameters improved significantly (RMI: preop/postop: 62.23% ± 31.63%/6.30% ± 11.51%, p < 0.001; CE: 11.53° ± 20.16°/30.58 ± 8.81°, p < 0.001; AI: 28.67° ± 9.2°/19.17 ± 7.65°, p < 0.001). Sub-group analysis showed a superior RMI in DDH compared with NDH 3 months after surgery (DDH/NDH: 2.77% ± 6.9%/12.94% ± 13.5%; p = 0.011). Osteotomy of the iliac bone (Salter innominate, Pemberton, Chiari) resulted in a significant improvement of the postoperative RMI compared to cases without osteotomy of the ilium (7.02 ± 11.1% vs. 16.85 ± 4.71%; p = 0.035). Conclusions: Femoral and pelvic osteotomies are effective to improve the radiological pelvic parameters in infants and adolescents with DDH, NDH and LCPD. In addition, the study found that the combination of femoral and pelvic osteotomy led to a better RMI than femoral osteotomy alone. Using the combined ilium and femoral osteotomy, it was possible to show the highest effect on correction of the hip geometry with respect to residual RMI.

Computer-assisted design model to evaluate the outcome of combined osteotomies in Legg-Calvé-Perthes disease

“…Coxa vara, LLD, limping, overgrowth, and impingement of the greater trochanter are not uncommon among patients who received the operations. To solve the problem, several surgeons ( 14 , 18 , 39 , 40 ) turned to the combined surgery and evaluated the outcomes to prove the effectiveness of this operative design.…”

Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes

“…Combined femoral and innominate osteotomies have been practiced by a few surgeons. [125][126][127][128] Weight-relief. Animal studies have shown that weight-relief does have a beneficial effect on maintaining the shape of the femoral head following induced ischemic necrosis 129 and a few surgeons advocate weight-relief as an adjunct to operative or non-operative containment.…”

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

“…Common surgical procedures for DDH patients include pelvic osteotomy, open reduction, capsular arthroplasty and femoral osteotomy[ 10 ]. To restore the anatomical morphology and mechanical structure of the pelvis and ensure normal development and life of children, pelvic osteotomy is almost inevitable[ 11 , 12 ]. Morphology of the acetabulum after pelvic osteotomy is closely related to prognosis of DDH.…”