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Mid term results of Pemberton pericapsular osteotomy
Mehmet Bülent Balioğlu1, Ali Öner2, Ümit Selçuk Aykut1
1Department of Orthopaedics and Traumatology, Baltalimanı Bone Diseases Research and Training Hospital, Istanbul, Turkey.
Insights
The Pemberton pericapsular osteotomy (PPO) shows comparable mid-term functional and radiological outcomes for treating developmental dysplasia of the hip (DDH) in children aged 16 months to 7 years.
Area of Science:
- Pediatric Orthopedics
- Hip Dysplasia Treatment
- Surgical Outcomes
Background:
- Developmental dysplasia of the hip (DDH) treatment is age-dependent, with surgical interventions like pelvic osteotomies for older children.
- Pemberton pericapsular osteotomy (PPO) is a surgical technique used for DDH.
- This study evaluates the outcomes of PPO in a specific pediatric age group.
Purpose of the Study:
- To evaluate the radiological and functional outcomes of Pemberton pericapsular osteotomy (PPO) in patients with developmental dysplasia of the hip (DDH).
- To assess the efficacy of PPO in children aged 16 months to 7 years.
Main Methods:
- A cohort of 12 patients (14 hips) with DDH underwent PPO between 2001 and 2006.
- Surgical procedures included PPO alone, PPO with open reduction (OR), or OR + PPO + femoral shortening.
- Radiological assessments (Acetabular index, Center-edge angle, Tönnis grade, Severin criteria) and clinical evaluations (McKay criteria, Kalamchi-MacEwen criteria) were performed with an average follow-up of 83.35 months.
Main Results:
- Significant improvement in Acetabular Index (AI) from 41.92° to 19.5° (P < 0.001).
- Postoperative Center-edge (CE) angle averaged 24.24°.
- Excellent to good functional outcomes (McKay criteria) were reported in 92.85% of patients.
- Radiological outcomes according to Severin's classification showed 78.57% of patients as Ia, and 85.71% as type I by Kalamchi-McEven criteria.
Conclusions:
- Pemberton pericapsular osteotomy (PPO) demonstrates effective mid-term radiological and functional results for treating developmental dysplasia of the hip (DDH).
- The study supports PPO as a viable surgical option for DDH in children aged 16 months to 7 years.
Background:
Treatment for developmental dysplasia of the hip (DDH) varies according to the age of the patient. For children under 3 months, the preferred treatment is Pavlik bandaging and/or dynamic hip orthosis;for children of 3-18 months (with/without arthrography), closed and open reductions (ORs) are most common; and for children 18 months and older, pelvic osteotomies are used. Radiological and functional outcomes of patients between 16 months and 7 years of age who underwent Pemberton pericapsular osteotomy (PPO) were evaluated.
Materials And Methods:
Twelve patients with developmental dysplasia of the hip (DDH) received treatment on 14 hips between 2001 and 2006. All patients with DDH had PPO as pelvic osteotomy. PPO was done solely in 3 hips, PPO and open reduction (OR) in and OR + PPO + femoral shortening in 6. The average age was 39.85 months (range 16-83 months). All had 1-stage surgery. Acetabular index (AI) and the grade of displacement were determined according to Tönnis'. Center-edge (CE) angle was evaluated. Clinical evaluations were made as described by McKay, radiological assessments by Severin's criteria and femoral head avascular necrosis measurements by Kalamchi-MacEwen's criteria. Average followup periods were 83.35 months (range 48-115 months).
Results:
Preoperative and postoperative average AI levels were 41.92° (range 30-50°) and 19,5° (range 5-34°), respectively (P < 0.001). According to Severin's classification, 11 (78.57%) patients were Ia, 1 (7.14%) was Ib, 1 (7.14%) was II and 1 (7.14%) was III. According to Kalamchi-McEven criteria, 12 (85.71%) patients were type I, 2 (14.28%) patients were type II. CE postoperatively was measured as 24.24° (range 12-41°). Clinically (McKay), the functional results in 13 (92.85%) patients were very good (I) and in 1 (7.14%) was good (II).
Conclusions:
Functional and radiological mid term outcomes were found to be comparable in most of the patients with DDH undergoing PPO between the ages of 16 months and 7 years.
