[Acetabular rotations y triple pelvic osteotomy by the Tönnis method]

Area of Science:

• Orthopedic surgery
• Hip joint biomechanics
• Surgical correction of hip dysplasia

Background:

• Acetabular labrum lesions often stem from anatomical abnormalities such as steep acetabulum or diminished femoral and acetabular anteversion.
• These conditions can lead to labral tension, traction, tears, and impingement, causing hip pain.

Purpose of the Study:

• To evaluate the efficacy of triple pelvic osteotomy in correcting acetabular and femoral anteversion abnormalities.
• To determine optimal acetabular positioning for pain relief and to assess long-term outcomes in terms of osteoarthrosis progression and pain recurrence.

Main Methods:

• A modified triple pelvic osteotomy technique with a posterior approach for ischial osteotomy was employed.
• Acetabular and femoral anteversion were corrected to 15-20 degrees.
• Postoperative measurements included CE angle, VCA angle, weight-bearing zone angle, and migration index.
• Long-term follow-up assessed osteoarthrosis progression and pain recurrence.

Main Results:

• Optimal hip joint alignment was achieved with specific ranges for CE angle (30-35°), VCA angle (30-35°), weight-bearing zone angle (+5° to -5°), and migration index (10-15%).
• Insufficient correction or overcorrection led to recurrent pain.
• Approximately 75% of patients with good corrections remained pain-free.
• 82.3% of 216 hips showed no change in osteoarthrosis after 5-10 years.

Conclusions:

• Triple pelvic osteotomy is an effective method for correcting acetabular and femoral anteversion issues causing labral lesions.
• Precise correction within optimal ranges is crucial to avoid pain recurrence.
• The surgical technique preserves acetabular circulation and ligamentous tension, contributing to favorable long-term outcomes.