Tectoplasty for painful dislocation or subluxation of the hip. Long-term evaluation of a new acetabuloplasty

Abstract

Tectoplasty is a new acetabuloplasty which aims to provide an extra-articular weight-bearing surface in cases of dysplastic acetabulum, hip subluxation or dislocation with a false acetabulum. The lateral wall of the iliac bone at the lateral edge of the affected acetabulum is raised as a proximally-based flap and massive bone grafts are inserted to provide a congruous, non-absorbable roof for the capsule and femoral head. An advantage is that the weight-bearing surface can be formed away from the original acetabulum, wherever the dislocated or subluxated femoral head may lie. Of 34 hips with congenital dislocation or severe subluxation treated by this method, 27 were evaluated after an average follow-up of 12 years. At review the patients averaged 35 years of age and satisfactory results with good relief of pain had been obtained in 78%. The results were unsatisfactory when degenerative changes had already developed before operation. Tectoplasty is indicated for pain due to congenital subluxation or dislocation of the hip under the age of thirty, in the absence of advanced osteoarthritis.

Bosworth hip shelf arthroplasty in adult dysplastic hips: ten to twenty three year results

“…The above overview shows that good long-term results of the shelf procedure may be expected in younger patients or patients with minimal or without osteoarthritic changes [10][11][12][24][25][26][27]. This is confirmed by our experience.…”

“…Despite good results published in the past [22][23][24][25], shelf operation is currently used mainly as a salvage procedure [9,21]. According to some authors, its main disadvantage is considered the fact that the bone graft does not ensure an adequate articulation for the femoral head cartilage [14].…”

“…Some studies evaluated outcomes in children, adolescents and adults together [10,12,[23][24][25][26][27]. Another problem is the indication of the shelf operation.…”

“…Another problem is the indication of the shelf operation. Evaluation of many groups is based primarily on the outcomes in subluxated or dislocated hips, less frequently in acetabular dysplasia [10,12,21,[23][24][25][26][27]. Some of these studies evaluated hips after septic arthritis, neuromuscular diseases, etc.…”

“…Migaud et al [11] evaluated 56 hips in 48 patients with a mean age of 32 years (range, 17-56) and a mean follow-up of 17 years (range, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Pre-operative joint space narrowing was observed in 32 of 56 shelf arthroplasties.…”