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Offset correction via the Hueter approach effectively eliminates the pistol grip deformity in dysplastic hips
Sufian S Ahmad1, Marco Haertlé1, Quentin Karisch1
1Hannover Medical School, Department of Orthopaedic Surgery, Anna-von-Borriesstr. 1-7, 30625 Hannover, Germany.
Insights
The Hueter approach provides excellent access for correcting posterolateral CAM deformities in dysplastic hips. This technique effectively eliminates the pistol-grip deformity, improving femoral offset prior to periacetabular osteotomy (PAO).
Area of Science:
- Orthopedic Surgery
- Hip Preservation Surgery
- Biomechanical Analysis
Background:
- Posterolateral CAM deformities pose surgical challenges due to their posterior location.
- Hip dysplasia with concomitant pistol-grip deformity is a rare but complex condition.
- The Hueter approach is evaluated for improved access to posterior femoral head-neck junction deformities.
Purpose of the Study:
- To assess if the Hueter approach enhances access to posterior CAM lesions in dysplastic hips.
- To determine the efficacy of correcting pistol-grip deformities via arthrotomy before periacetabular osteotomy (PAO).
- To evaluate the impact on femoral offset and hip coverage.
Main Methods:
- Retrospective analysis of 342 periacetabular osteotomies (PAOs).
- Identified 17 dysplastic hips with pistol-grip deformity treated with Hueter approach and PAO.
- Collected preoperative and postoperative radiographic measures of hip coverage and femoral offset.
Main Results:
- The Hueter approach effectively corrected the pistol-grip deformity in all 17 hips.
- Significant reduction in α-angle demonstrated restoration of physiological femoral offset (p < 0.0001).
- Combined procedure required significantly more surgical time compared to isolated PAO (p < 0.0001).
Conclusions:
- The Hueter approach provides excellent access to posterolateral CAM lesions in dysplastic hips.
- Arthrotomy via the Hueter approach allows correction of posterior CAM deformities before PAO.
- This technique effectively addresses the pistol-grip deformity in conjunction with hip dysplasia correction.
Objectives:
Large posterolateral CAM deformities represent a technically challenging entity due to the posterior location of the asphericity at the head-neck junction. The aim of this study was to determine whether access to the posterior CAM is improved in patients with concomitant hip dysplasia via a Hueter approach. It was hypothesized that an arthrotomy prior to periacetabular osteotomy (PAO) via the Hueter approach would allow for the elimination of the pistol-grip deformity in dysplastic hips.
Methods:
A single-surgeon series of 342 PAOs performed between June 2023 and May 2025 was retrospectively assessed. Seventeen hips with dysplasia and a concomitant pistol-grip deformity were identified. Preoperative and postoperative measures of global femoral-head coverage (lateral center-edge angle, acetabular index, extrusion index, anterior and posterior wall indices) and femoral offset (anteroposterior and axial α-angles) were collected. The elimination of the pistol-grip deformity was confirmed independently by two observers. A matched cohort of isolated-PAO hips served to compare surgical time.
Results:
There were only 17 (4.97%) dysplastic hips undergoing PAO with a concomitant pistol-grip deformity, indicating that this is a rather rare combination of pathologies. Of these, 11 (64.71%) were male. The femoral offset correction performed via the Hueter approach effectively restored a physiological offset as shown by a statistical significant reduction in the α-angle on anteroposterior (88.51 ± 13.17° to 60.86 ± 16.24°, p < 0.0001) and axial (82.49 ± 10.37° to 51.31 ± 11.21°, p < 0.0001) radiographs. The pistol-grip deformity was completely eliminated in all 17 hips. The combined procedure of PAO and femoral offset correction required statistical significantly more surgical time than isolated PAO (101.06 ± 21.34 min vs. 56.06 ± 16.75 min; p < 0.0001).
Conclusions:
These findings demonstrate that, in dysplastic hips, excellent access to the posterolateral CAM lesion characteristic of the pistol-grip deformity can be achieved. The posterior CAM deformity can be corrected through an arthrotomy via the Hueter approach, making use of the acetabular undercoverage to correct the posterior CAM, prior to performing the reorientation to correct dysplasia.
Level Of Evidence:
Level IV.
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