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Complete transiliac pelvic osteotomy for patients with developmental dysplasia of the hip without internal fixation
Haldun Orhun1, Volkan Gurkan, Ilhan Bayhan
1Department of Orthopedics and Traumatology Clinic 1, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. haldunorhun@hotmail.com
Insights
This study shows a modified pelvic osteotomy effectively treats hip dysplasia in children aged 4-8, improving hip coverage and stability without needing secondary surgery.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Pelvic osteotomy for hip dysplasia presents challenges like graft instability and avascular necrosis.
- Addressing these issues is crucial for successful treatment outcomes in pediatric patients.
Purpose of the Study:
- To evaluate the outcomes of a modified step-cut pelvic osteotomy in children aged 4-8 with hip dysplasia.
- To assess the technique's efficacy in improving hip coverage, stability, and reducing complications.
Main Methods:
- Retrospective review of 14 hips in 12 patients (ages 4-8) treated with modified pelvic osteotomy between 1994-1999.
- Clinical assessment using Severin criteria and radiological evaluation with Tonnis criteria.
- Analysis of center-edge angle, graft stability, avascular necrosis, hip motion, and Trendelenburg's sign.
Main Results:
- Significant improvement in center-edge angle (from -11.20 to 22.30).
- 80% normal coxofemoral positioning, 84% full hip range of motion, 84% negative Trendelenburg's sign.
- No graft shift or loss; 8% incidence of avascular necrosis.
Conclusions:
- The modified pelvic osteotomy provides stable graft incorporation and effective correction of hip dysplasia in young children.
- This technique eliminates the need for fixation and secondary surgery, conserving bone and improving outcomes.
Abstract:
Several problems are encountered with pelvic osteotomy in hip dysplasia including insufficient coverage, avascular necrosis, graft instability and fixation of secondary bone grafts. We evaluated results of pelvic osteotomy in 4-8 year olds in our institution. 44 cases of developmental dysplasia of the hip between 1994 and 1999 were reviewed. 14 hips in 12 patients were treated with a step-cut osteotomy and the results are discussed. The mean age was 5.6 (range: 4-8) years, and mean follow up was 87.7 months (60-120). The patients were followed up according to the Severin clinical assessment criteria, and their radiological findings were evaluated and classified in accordance with the Tonnis criteria. Radiologically, a marked correction was obtained in center-edge angle, which was increased to 22.30 from the preoperative value of -11.20. No graft shift or loss was observed in any cases. There was also no loss in coverage achieved by surgical intervention. Coxofemoral positioning was found to be normal in eighty percent of cases. 8% of cases had avascular necrosis. Full range of hip motion was achieved in 84% of cases, and 84% of cases exhibited negative Trendelenburg's sign. The modified osteotomy we describe eliminated the need for fixation and secondary surgery. Graft stability and bone conservation were achieved.
