Hip Reconstruction Using Pelvic Support Osteotomy of Two Cases with Review of Literature

Neglected hip pathologies in adolescents frequently result in pain, instability, limb-length discrepancy, and significant gait abnormalities, posing complex reconstructive challenges. In such cases, total hip arthroplasty is often unsuitable due to young age and altered anatomy. Pelvic support osteotomy (PSO) with Ilizarov modification serves as a viable biological reconstruction option aimed at restoring stability, alignment, and limb length. We report two adolescent patients with chronic hip sequelae-one following septic arthritis and the other with developmental dysplasia of the hip-who underwent proximal pelvic support osteotomy combined with distal femoral osteotomy and application of a limb reconstruction system. Gradual postoperative distraction and early weight-bearing were initiated as per protocol. Both patients demonstrated significant improvement in hip stability, correction of limb alignment, and enhancement of functional outcomes as assessed by the Harris Hip Score. Radiological union was achieved in all osteotomy sites. One patient developed knee stiffness during the course of treatment and subsequently required quadricepsplasty, following which satisfactory knee range of motion was restored. At final follow-up, both patients achieved functional limb length, improved gait pattern, and satisfactory clinical outcomes. Pelvic support osteotomy with Ilizarov modification is an effective reconstructive strategy in adolescents with neglected hip conditions, offering restoration of hip stability, limb alignment, and function. Meticulous preoperative planning, adherence to physiotherapy, and close follow-up are crucial to achieving optimal results.