Periacetabular Osteotomy for Treatment of Acetabular Dysplasia through Iliofemoral approach

PURPOSE: To evaluate the clinical and radiologic results of periacetabular osteotomy, for treating acetabular dysplasia through iliofemoral approach. MATERIALS AND METHODS: We evaluated the results of 17 periacetabular osteotomies performed in 17 patients (12 female, 4 male). The osteotomies were performed through an iliofemoral approach in 17 hips. The mean age of the patients at the time of surgery was 34.7 years (range: 14~61 years). The average follow-up period was 26 months (range: 12~48 months). The D'Aubigine and Postel score was used for clinical evaluation. Radiological changes of acetabular head index, the CE angle (lateral and anterior), and the sharp angle were measured, respectively. RESULTS: Clinically, the mean D'Aubigine and Postel scores improved from 12.7 preoperatively to 15.1 postoperatively. All four radiological measurements improved significantly after surgery (Wilcoxon Rank Sum test: p< 0.05). The following complications were noted: posterior column fracture in 2 hips and peripheral nerve dysfunction was noted in 5 patients. Of these nerve palsy, lateral femoral cutaneous nerve palsy in 3 patients, 1 patient complained troublesome, transient sciatic nerve palsy and femoral nerve palsy in 1 patient. There were no vascular complications or heterotopic bone formation and conversion to total hip arthroplasty. CONCLUSION: Periacetabular osteotomy by the iliofemoral approach is an effective surgical treatment for acetabular dysplasia in adults, but should be careful nerve injuries.

Modified Iliofemoral Approach using ASIS Osteotomy in the Pelvis / 대한정형외과학회잡지

Operations on the inner aspect of the pelvis are often necessary for irreducible fracture of the ilium, irreducible fracture of superior and medial portion of the acetabulum, tumors and infections involving iliac fossa, and fracture-dislocation and infection of the sacro-iliac joint. Until now Letournel and Judet's ilioinguinal and iliofemoral approaches provided access to anterior column of the pelvis by elevating muscle layer on inner aspect of the pelvis. We used modified iliofemoral approach using ASIS(anterior superior iliac spine) osteotomy to gain better access to anterior column, the pelvlc brim, and in some occasions as far as anterior sacroiliac joint while avoiding injury to the structures in the inguinal ligament and lateral femoral cutaneous nerve and reported six cases treated with this approach. In conclusion, a modified iliofemoral approach using ASIS osteotomy is a useful approach which can obtain an excellent exposure in the inner pelvis.