Triple osteotomy of the pelvis for acetabular dysplasia

Abstract

We investigated the variables which determine the outcome after triple osteotomy of the pelvis for the treatment of congenital dysplasia of the hip. We reviewed 51 patients (61 hips) with a median age at operation of 23 years who were treated with a Tönnis triple osteotomy. The median follow-up was six years with a minimum of two years. Eight patients (eight hips) required a revision procedure. Of the remaining 53 hips, the results were good or excellent in 36 (68%) when evaluated according to the Harris hip score (median 90 points), and 33 patients (65%) were satisfied with the procedure. Logistic regression analysis indicated that the incidence of complications such as nonunion at an osteotomy site influenced patient satisfaction (p = 0.079). The incidence of complications correlated positively with increasing patient age at operation (p = 0.004). The amount of acetabular correction did not correlate with patient satisfaction. In univariate analysis, the groups of 'satisfied' and 'not satisfied' patients differed significantly in Harris hip score, age, incidence of nonunion at the osteotomy sites, complications and late revisions. In conclusion, the patient's age at operation and the incidence of complications influence patient satisfaction after triple osteotomy, but the amount of radiologically evident acetabular correction shows no correlation to outcome.

Screw fixation after tripe pelvic osteotomy is reliable: changes of acetabular correction are rare and do not correlate with risk factors

“…Second, this examination focused on the dynamics of the acetabular fragment in the first 12 weeks after TPO, leaving the further clinical course outside. Hence, an impact on the clinical outcome or on the healing of the osteotomy sites cannot be foreseen [ 19 – 24 ]. Third, the predominately used pattern of acetabular fragment fixation (see above) had to be modified in some cases, e.g., when a crossing of the 4.5 mm steel screws in a thin iliac bone was not feasible without a collision of the implants.…”

The influence of triple pelvic osteotomy on birth canal size

“…pelvic deformity caused by abnormal development, or secondary, when alteration of the birth canal occurs as a result of surgical procedures conducted during childhood and adolescence increasing the risk to mother and fetus. There are many surgical procedures that can improve biomechanics and increase the load-bearing area of the hip joint (1–2–3–4–5–6, 11, 13–14–15–16). One of the treatment methods for residual dysplasia of the hip is triple pelvic osteotomy (TPO), which is based on osteotomy of the ilium, the ischium and the pubis and a subsequent change in the position of the acetabular fragment.…”