Ganz Osteotomy for DDH


- 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;
                  - compartment of the tensor fasciae latae is entered and the muscle bluntly dissected off the septum along with the sartorius muscle
                  - superior joint capsule is well exposed and posterior joint and notch is palpated;
                  - subperiosteal dissection of the inner table of the ilium is performed;
                  - protect the lateral femoral cutaneous nerve;
           - medial exposure:
                  - iliacus and sartorius are elevated off their attachments to ASIS and iliac wing;
                  - sartorius may be detached with a thin wafer of bone that will be repaired with suture at the end of the procedure
                  - rectus insertion to the AIIS is elevated and reflected attachment to the capsule is divided;
                  - direct head of the rectus femoris and the underlying capsular portion of the iliacus are elevated as a unit and reflected distally and medially from the underlying joint capsule;
                  - dissection is complete when psoas tendon, pubis, and iliopectoneal line are exposed;
                  - iliacus, sartorius, and abdominal contents are then reflected medially;
                  - sheath of the psoas may be opened longitudinally and its muscle and tendon retracted medially
                  - 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 psoas tendon and distal joint capsule, and then chisel  is applied against 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.   

Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips.

Surgical Correction of Residual Hip Dysplasia in Two Pediatric Age-Groups

Intermediate to Long-Term Results Following the Bernese Periacetabular Osteotomy and Predictors of Clinical Outcome. Surgical Technique



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 13, 2012 11:56 am