Triple pelvic osteotomy: Report of our mid-term results and review of literature

Abstract

A wide variety of pelvic osteotomies have been developed for the treatment of developmental dysplasia of the hip (DDH). In the present paper, we present a detailed review of previous studies of triple osteotomy as an alternative treatment for DDH. We also report our experience treating 6 adult cases of DDH by triple osteotomy in order to highlight the various aspects of this procedure.The mean age of our patients was 31.2 years with a mean follow-up period of 6 years. We assessed range of motion, center-edge angle, acetabular index angle, Sharp angle, acetabulum head index, head lateralization index, Japanese Orthopedic Association score, Harris hip score, patient satisfaction, and the difference between lower limb lengths before and after the procedure. At final follow-up, clinical scores were significantly improved and radiographic parameters also showed good correction of acetabulum.

Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years

“…Among the various methods of pelvic osteotomy, the most widely known is that of Salter, Pemberton and Dega, which is used to redirect the true acetabulum in order to obtain femoral head coverage [ 13 – 15 ]. The Steel and Chiari osteotomy was used to older children [ 16 , 17 ]. Many authors have reported success with a single-stage procedure consisting of open reduction, capsulorrhaphy, femoral shortening, and pelvic osteotomy [ 10 , 12 , 18 , 19 ].…”

Triple nonunion after steel-like triple pelvic osteotomy

“…[5,8] Triple pelvic osteotomy mainly aims to achieve good containment of the femoral head and stability of the hip joint; thus, it is widely used for management of developmental dysplasia of the hip. [9] Pauwels, in 1965, reported that functional anatomical evidence suggests that while sitting load is vertically transferred from the ischial tuberosity to the sacroiliac joint; subsequently, vertical compressive forces from the ischial tuberosity cause shear forces at the ischial osteotomy site, at which point routine fixation is not applied in TPO. [10] In addition, forces that act on the symphysis pubis can deform the inferior pubic ramus.…”

“…[1][2][3] We assume that the surgeon conducted ischial osteotomy closer to the acetabulum compared to Steel's triple osteotomy (adjacent to the hip joint) to allow an easier rotation of the acetabulum. [9] Steel [1] reported no incidence of nonunion in their original article whereas Tönnis et al [2] reported one patient with pseudoarthrosis of the pubic ramus in their own series. A study by Tschauner et al, [5] comprising 409 TPOs using the Tönnis technique, reported five cases of double nonunion, but no triple nonunion.…”

Minimally invasive (MIS) Tönnis osteotomy– A technical annotation and review of short term results

“…First described by Le Coeur in 1965, it has since undergone multiple modifications and refinements. 1 A common feature of the early techniques is that they described osteotomies of the pubic ramus and ischium far away from the acetabulum, thereby restricting the fragment mobility. It was Tönnis and Carlioz who demonstrated that the juxta-acetabular ischial cut could untether the acetabular fragment from the tight grasp of sacrospinous and sacrotuberous ligaments, resulting in greater mobility of the acetabular fragment.…”