- See:
DDH:
- Discussion:
- indicated for residual dysplasias in adolescents and young adults;
- allows both anterior and lateral rotation as well as medialization of the hip;
- can expect good improvement in the
center edge angle (avg correction of 31 deg);
- does not change the diameter of the true pelvis (allows for subsequent child birth);
- posterior column of the hemipelvis is not violated, which allows minimal internal fixation and early mobilization;
- vascular supply via
inferior gluteal artery is maintained;
- Technical Considerations:
-
exposure:
-
ilioinguinal approach or
smith peterson approach is typically used;
-
lateral exposure:
- abductor musculature should not be violated but tensor fascia lata is elevated from its attachment;
- superior joint capsule is well exposed and posterior joint and notch is palpated;
-
medial exposure:
-
iliacus and
sartorius are elevated off their attachments to ASIS and iliac wing;
-
rectus insertion to the AIIS is elevated and reflected attachment to the capsule is divided;
- dissection is complete when
psoas tendon, pubis, and iliopectoneal line are exposed;
- define gap between the psoas and the joint capsule;
-
osteotomy cuts:
-
partial (incomplete) osteotomy of the ischium;
- exposure:
- procedes through the space between the psoas tendon and the distal joint capsule;
- infracotyloid groove (posterior inferior rim of the acetabulum) is palpated
- cautions:
obturator artery is medial and
medial femoral circumflex artery is postero-lateral;
- flouro is used to direct chisel placement;
- angled chisel is inserted through space between the psoas tendon and the distal joint capsule, and then the chisel
is applied against the infracotyloid groove;
- chisel is hammered 5-10 mm without attempts to complete the osteotomy;
-
complete osteotomy of the pubis;
- assurance is made that soft tissues (including
obturator nerve) are protected;
- osteotomy is made just in front of the acetabulum;
-
biplanar roof shaped osteotomy of the ilium;
- consists of an anterior and posterior limb which form an agle of 110-120 deg (appex superior);
- inner and outer borders of the ilium are scored with an osteotome;
- be aware of the potential for a large intra-osseous artery which may require hemostasis with bone wax;
- anterior limb:
- osteotmy procedes superior to the AIIS
- extends to the posterior margin of the capsule;
- posterior limb:
- is directed toward to the ischial spine (do not enter into the joint or
sciatic notch);
- outline the osteotomy along the inner and outer iliac tables;
- only the first 15 mm needs to be fully osteotomized;
-
correction of deformity:
- half pin is inserted anteriorly through the supra-acetabular fragment without entering into the joint;
- completion of triple osteotomy;
- quadrilateral surface is exposed down to obturator foramen;
- osteotome is inserted approx 4 cm below the pelvic brim and is impacted until fracture is completed
through the infra-cotyloid groove;
- acetabular fragment is rotated anterior and laterally (maintaining anteversion) and is then medialized;
- acetabular fragment is secured with three long cortical 4.5-mm screws;
-
closure:
- AIIS is removed and can be used as bone graft into the anterior gap of the transverse osteotomy;
- repair the
sartorius and
rectus femoris muscle origins;
- Complications:
- intra-articular fracture
- femoral nerve palsy
- nonunion
- ectopic bone formation
Dome osteotomy of the pelvis for osteoarthritis secondary to hip dysplasia. An over five-year follow-up study.
Pelvic displacement osteotomy for chronic hip dislocation in myelodysplasia.
A combination pelvic osteotomy for acetabular dysplasia in children.
Rotational acetabular osteotomy for the dysplastic hip.
Triple osteotomy of the pelvis. A review of 51 cases.
Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult.
A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.
Factors influencing the results of acetabuloplasty in children.
Osteotomy of the hip in children: posterior approach.
The hip-shelf procedure. A long-term evaluation.
Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip.
PA Pemberton.
JBJS Vol 47-A. 1965. p 65.
Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips.
Surgical Correction of Residual Hip Dysplasia in Two Pediatric Age-Groups
