- See:
DDH:
- Discussion:
- provides excellent congruity at site of osteotomy, rapid healing, & intrinsic stability with only minimum internal fixation;
- performed thru Anterior Approach;
- specially curved gouges are used to divide acetabulum from surrounding
pelvis thru osteotomy site 15 mm from articular surface;
- hip capsule is not violated inorder to preserve femoral head blood supply;
- type I osteotomy:
- single spherical osteotomy and simple rotatory
displacement;
- more spherical osteotomies provide good lateral and anterior coverage but are limited with regard to the correction of
version and mediolateral displacement;
- there is no lengthening, shortening, medialization, or lateralization;
- quadrilateral plate remains intact & prevents medialization;
- in the study by M Schramm et al (JBJS Vol 81-B. Jan 1999), the authors noted that a spherical acetabular osteotomy improved
the
center edge angle from - 3 to + 15 deg;
- these patients require sufficient articular surface in the posteroinferior quadrant to allow reorientation;
- osteotomies may result in a defect between the osteotomized fragment and the ischium if major corrections are performed;
-
Dega Osteotomy:
- incomplete transiliac osteotomy which penetrates the anterior and middle portions of the inner cortex
of the ilium, leaving an intact posterior hinge (intact posteromedial iliac cortex and sciatic notch);
- supine position w/ involved hip rotated 30-40 deg;
- anterolateral incision is made from 1 cm inferior and posterior to ASIS and extending
distally over the proximal femur;
- define interval between tensor fasciae latae muscle and sartorius;
- sartorius is released from its origin on the anterior superior iliac spine;
- abductor muscles are dissected off lateral wall of the ilium, distal to the iliac apophysis (apophysis itself is not split);
- abductor muscles and the periosteum are completely separated from the ilium and the hip capsule;
- sciatic notch is exposed and visualized with Hohman retractor inserted into the notch;
- soft tissues along inner wall are left undisturbed;
- rectus femoris muscle is dissected off hip capsule;
- rectus femoris muscle may be detached from the AIIS when necessary;
- psoas tendon is dissected from the capsule and is transected;
- open reduction of the hip and/or concomitant femoral osteotomy with shortening and rotation to correct
excessive anteversion can be performed if necessary;
- osteotomy:
- just above the middle of the acetabulum is the most cephalad portion of the osteotomy;
- very steep acetabular inclinations require a correspondingly
- flouroscopy is used to help plan the osteotomy;
- when more anterior coverage is required, the inner cortex is transected over the anterior and
middle portion, which leaves posterior sciatic notch hinge intact;
- when lateral coverage is required, more of the medial cortex is left intact, which creates the posteromedial
hinge based on the posteromedial inner cortex and the entire sciatic notch;
- hinge portion is variable and may include sciatic notch, the posterior aspect of the inner pelvic cortex, the horizontal
limb of the triradiate cartilage, and the symphysis pubis;
-
outcomes:
- in the report by Jan S. Grudziak, MD, PhD and W. Timothy Ward, MD the authors evaluated 22 children (24 hips) with
an average age of 5 years and 10 months and varying degrees of congenital hip dysplasia, subluxation, or
dislocation were treated with a Dega osteotomy;
- 20 hips (83%) had a concomitant femoral osteotomy and thirteen (54%) had an anterior open
reduction of the hip in addition to the Dega osteotomy;
- radiographs were reviewed to determine the acetabular index, the center-edge angle, whether the Shenton
line was intact or broken, and any change in the projection of the obturator foramen;
- at an average of 55 months postoperatively, all patients demonstrated unlimited physical activity and no limp;
- average acetabular index changed from 33° preoperatively to 12° at the time of follow-up;
- center-edge angle ranged from less than -30° to 18° preoperatively and from 18° to 40° (average, 31°)
at the time of follow-up;
- change in the obturator foramen was observed in fourteen hips (58%)p
- Shenton line was broken in seventeen hips preoperatively but in none postoperatively.
- ref: Dega Osteotomy for the Treatment of Congenital Dysplasia of the Hip
Jan S. Grudziak, MD, PhD and W. Timothy Ward, MD.
JBJS (Am) 83:845-854 (2001)
- type-II osteotomy:
- involves combination of rotation of acetabular fragment & lengthening;
- accomplished thru placement of an iliac bone graft in the cleft between
rotated acetabular fragment and the overlying ilium;
- indicated for dysplastic limb w/ shortening;
- type-III osteotomy:
- involves both acetabular realignment and medialization;
- performed by creating a spherical acetabular osteotomy along w/ a
Chiari-like cut proximally;
- this allows both realignment and medial displacement to be performed;
- stabilization utilizes K wires connected by a semitubular plate;
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
