Clinical effect of periacetabular osteotomy in the treatment of hip dysplasia / 中国综合临床

Object:To explore the clinical effect of periacetabular osteotomy (PAO) in the treatment of developmental dysplasia of hip (DDH).Methods:The clinical data of 305 patients with DDH admitted to Tangshan Second Hospital from January 2012 to June 2018 were analyzed retrospectively. All patients were treated with PAO alone. There were 123 cases of left hip dysplasia, 131 cases of right hip dysplasia and 51 cases of double hip dysplasia (356 hips in total). The patients underwent X-ray examination before and on the second day after operation to compare the acetabular index and the lateral center edge angle (LCEA) and the anterior center edge angle (ACEA) of the acetabulum before and after operation. The ability of daily living and hip joint function were evaluated before and 6 months after operation, and Barthel index and Harris score of hip joint were compared before and after treatment. The measurement data with normal distribution are expressed in xˉ± s, and the paired t test was used for comparison before and after operation. The measurement data of non-normal distribution is expressed by M( Q1, Q3), and the comparison before and after surgery is performed by the rank sum test. Results:On the second day after operation, the LCEA and ACEA of 356 hip joints in 305 patients were greater than those before operation (32.5(20.0,47.5)° vs 8.5(-18.5 23.0)°, 29.0(18.5,52.3)° vs 2.5(-20.8, 24.5)°), while the acetabulum index was lower than that before operation (6.7(-8.4,12.5)° vs 26.8(10.0, 62.3)°), and the differences were statistically significant ( Z values were 51.50, 45.37, 32.22, all P<0.001). After 6 months of follow-up, the Barthel score and Harris score of the hip joint were higher than those before the operation (92.5±1.3) scores vs (65.6±1.5) scores, (96.4±2.5) scores vs (85.1±1.3) scores, and the difference was statistically significant ( t values were 335.56 and 89.70, both P<0.001). Conclusions:PAO can make the acetabulum cover the femoral head well through acetabular transposition, improve the ability of daily living and hip joint function of DDH patients, reduce pain, increase joint range of motion, and correct limb deformities. It is an effective means to treat DDH.

Stress Distributions of Hip Cartilage During Gait Cycle and its Effects in Curved Periacetabular Osteotomy / 医用生物力学

Objective To study stress distributions of the cartilage around the hip joint in stress environment of complete gait cycle, and explore the optimal correction angle of bone block in curved periacetabular osteotomy (CPO), so as to provide theoretical references for clinical operation. Methods Based on CT scans from a healthy volunteer and a patient with development dysplasia of hip (DDH), the three-dimensional (3D) model including pelvis and proximal femur was reconstructed. The cortical bone and cancellous bone were distinguished by dividing the masks, and the material attributes were assigned to the finite element model. A total of 100 different postoperative models were obtained by simulating CPO in DDH model, by adjusting lateral center edge angle (LCEA) and anterior center edge angle (ACEA). According to hip joint stresses in complete gait cycle, the model was loaded respectively, and stress changes of normal, preoperative and postoperative acetabular cartilage were analyzed and compared. ResultsThe minimum peak contact stresses of acetabular cartilage of DDH patient at heel landing phase, start phase of single leg support, mid phase of single leg support, end phase of single leg support and double support phase after simulated CPO operation were 5.273, 6.128, 7.463, 6.347, 6.582 MPa, which were decreased by 2.159, 2.724, 2.249, 2.164, 2.119 MPa,respectively, compared with those before operation. The contact area between femoral head and acetabulum was significantly increased after operation, but it was still smaller than that of normal volunteers. Conclusions The optimal correction angle of LCEA and ACEA can be obtained by using finite element method, and the simulation of CPO surgery on different patients is of great significance to improve surgical accuracy and efficiency.

Hallazgos artroscópicos de la cadera en pacientes con indicación de osteotomía periacetabular / Arthroscopic findings of the hip in patients with indication of periacetabular osteotomy

Introducción La displasia de la cadera en desarrollo (DCD) produce cambios anatómicos que dan lugar a artrosis precoz. Dentro de los procedimientos quirúrgicos indicados, se encuentra la osteotomía periacetabular de Ganz, diseñada para mejorar la arquitectura de la cadera, que por sí sola, no mejora el daño del cartílago articular, además de posibles lesiones del labrum. El objetivo fue describir hallazgos artroscópicos encontrados en caderas con displasia e indicación de osteotomía periacetabular de Ganz. Materiales & Métodos Estudio observacional tipo serie de casos, basado en la revisión de los registros clínicos (descripción quirúrgica y video de la artroscopia) de todos los casos con diagnóstico de displasia de cadera e indicación de osteotomía periacetabular de Ganz, en quienes se realizó artroscopia antes de la osteotomía. Resultados La artroscopia de cadera demostró compromiso intra-articular en 76,9% de los casos estudiados (10 de 13). Seis casos tenían compromiso del cartílago articular en las zonas geográficas 2, 3 y 4, adicionalmente se observó compromiso de la unión condrolabral en seis casos y el daño a nivel del labrum, se detectó en 5 casos; con respecto al offset cabeza-cuello femoral, se encontró disminuido en 5 casos. En una de las caderas, se contraindicó la osteotomía periacetabular por el grado de compromiso del cartílago articular. Discusión La DCD es una condición clínica que predispone al daño de estructuras articulares con alta frecuencia, que pueden ser tratadas de forma artroscópica con el fin de evitar la persistencia de síntomas después de una osteotomía periacetabular o incluso contraindicarla.

Background Dysplasia of the hip in development (DHD) produces anatomical changes that cause premature arthrosis. Within the surgical procedures indicated, Ganz periacetabular osteotomy has been described. It is designed to improve the architecture of the hip that, by itself, does not improve the damage to the articular cartilage, as well as possible lessions of the labrum. The objective was to describe the arthroscopic findings found in hips with dysplasia and indication of Ganz periacetabular osteotomy. Method Case series type observational retrospective study based on the review of surgical descriptions and videos of all cases with diagnosis of hip dysplasia and indication of Ganz periacetabular osteotomy where arthroscopy of the hip was performed prior to the osteotomy. Results Hip arthroscopy showed intra-articular compromise of 76.9% of the cases studied (10 of 13). Six cases had compromise of the articular cartilage in the 2, 3 and 4 geographic zones. In addition, compromise of the chondrolabral joint was observed in 6 cases and damage at the labrum level was detected in 5 cases. In regard to the femoral head-neck offset, it was found to be reduced in 5 cases. In one of the cases periacetabular osteotomy was contraindicated due to the level of compromise of the articular cartilage. Conclusions DHD is a clinical condition that is very frequently predisposed to damage of the articular structures; they can be treated with arthroscopy with the aim of avoiding persistence of sypmtoms after a periacetabluar osteotomy or even contraindicating it.

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.

Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 +/- 0.57 m/sec2 preoperatively to 1.55 +/- 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20degrees could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.

Short to Midterm Results of Bernese Periacetabular Osteotomy for Hip Dysplasia / 대한정형외과학회잡지

PURPOSE: The goal of this study was to analyze the short to midterm results of Bernese periacetabular osteotomy for the patient with hip dysplasia. MATERIALS AND METHODS: Fourteen Bernese periacetabular osteotomies were performed in 13 patients and were followed-up for more than 2.5 years. All patients had been treated at Department of Orthopedic Surgery, Seoul National University Hospital from June 1998 to December 2007. We conducted an interview and asked the patients to complete the Harris hip score and pain visual analogue scale (VAS) score for clinical evaluation. Radiographic measurements included Tonnis osteoarthritis grade, center-edge angle of Wiberg, acetabular angle of Sharp, acetabular depth index, acetabular head index. RESULTS: Mean Harris hip score improved from 63.8 points preoperatively to 82.9 points postoperatively and pain VAS score improved from 7.6 points preoperatively to 0.8 points postoperatively. Based on Tonnis osteoarthritis grade, progression of osteoarthritis was found in 4 hips. Radiologically, center-edge angle of Wiberg, acetabular angle of Sharp, acetabular depth index and acetabular head index improved. Complications included superficial skin infection in one hip and non-union of pubic ramus in one. One patient had metal hypersensitivity to cortical screws and fracture of posterior column. CONCLUSION: The short to midterm results show Bernese periacetabular osteotomy is a satisfactory technique for treating early and mild hip-osteoarthritis patients with hip dysplasia clinically and radiographically.

Short-Term Follow-up Results of Periacetabular Osteotomy for Hip Dysplasia

PURPOSE: To evaluate the clinical and radiologic results of periacetabular osteotomy for the treatment of hip dysplasia. MATERIALS AND METHODS: We performed a clinical and radiological assessment of 20 periacetabular osteotomies (19 patients), which had been followed up for > 1 year. The mean age of the patients at the time of surgery was 34.2 years (range, 18~50 years). The average follow-up period was 26.7 months (range, 12~85 months). The Harris hip score and range of motion were used for clinical evaluation. The radiologic measurements were evaluated using the acetabular angle, center-edge angle, acetabular depth, femoral head coverage, and medialization. RESULTS: The mean Harris hip score improved from 59.6 points to 96.4 points. The mean acetabular angle improved from 47.9 degrees to 26.4degrees. The mean center-edge angle increased from 14.2degreesto 41degrees. The acetabular depth increased from 176 to 242.7 The mean femoral head coverage increased from 63.3% to 95.4%. The following complications were noted: hematoma in 2 cases, temporary lateral femoral cutaneous nerve palsy in 3 cases, and superficial wound infection in 1 case. CONCLUSION: Periacetabular osteotomy is an effective surgical treatment for hip dysplasia.

Osteotomies Around the Hip Joint

The goal of an osteotomy around the hip joint for treating hip dysplasia is to delay or prevent osteoarthritis by reducing the stress to the hip joint. This can be archived with anterolateral displacement of the acetabulum and an osteotomy around the hip joint is indicated for the young and active patients, besides performing total hip arthroplasty. As the osteotomy site is close to the hip joint, we can obtain more correction with performing this type of surgery than is possible with other types of pelvic osteotomies and we can get excellent radiological and clinical outcomes. But periacetabular rotational osteotomy is a rather difficult procedure, there may be complications and a long learning curve is needed to learn the surgical technique. A dual approach for periacetabular rotational osteotomy is easier with direct exposure of the osteotomy site and there are fewer complications than that with performing a Berneses periacetabular rotational osteotomy, as described by Ganz. Therefore, it is recommended for beginners. The osteotomy site of the proximal femur is usually around the lesser trochanter, but femoral neck osteotomy may be performed in rare cases. The preoperative planning for obtaining a correction angle of the osteotomy site is the most important factor, and excellent results can be archived by performing an accurate procedure.

Periacetabular Osteotomy for Treating Dysplastic Hips That Were Misdiagnosed as Having Acetabular Bone Tumor: Report of Two Cases

The incidence of primary bone tumor of the acetabulum is 1-2% of all the bone tumors. Degenerative cystic change can occur in patients with hip dysplasia and this can be misdiagnosed as primary bone tumor. We have experienced 2 patients with painful dysplastic hips that were treated with curettage and autogenous bone graft for a cystic lesion that was originally misdiagnosed as primary bone tumor. The patients'hip pain and limitation of motion recurred, and so Bernese periacetabular osteotomy was performed for the dysplastic hips. At over one year follow-up, the corrected hips showed a painless and good range of motion.

Periacetabular Osteotomy in Hip Dysplasia with Deformed Femoral Head / 대한정형외과학회잡지

PURPOSE: To evaluate the results of a periacetabular osteotomy (PAO) combined with a femoral osteotomy (FO) for a dysplastic hip with a deformed femoral head. MATERIALS AND METHODS: Thirteen hips with dysplasia and a deformed femoral head were followed up for more than 12 months. Eight hips were in the PAO group and 5 hips were in the PAO and FO group. The two groups were compared clinically according to the HHS (Harris hip score), pain and limping VAS (visual analogue scale), and radiologically according to the CEA (central edge angle of Wiberg), Tonnis angle (acetabular index of weight bearing surface), FHC (femoral head coverage), AA (acetabular angle of Sharp), DBSPFH (distance between symphysis pubis and femoral head) and AI (acetabular index of depth to width). RESULTS: Regarding the clinical results, the PAO group showed improvement in the HHS from 66.5 preoperatively to 90.4 postoperatively (p=0.01) and the pain VAS from 6.7 to 1.9 (p=0.01). However, there was no significant improvement in limping (p=0.39). In the PAO with FO group, the HHS was improved from 78 to 91 (p=0.04). Radiologically, the CEA, Tonnis angle, FHC, AA and AI improved significantly but there were no significant improvement in the DBSPFH in the two groups. In addition, there was no significant clinical or radiological difference between the two groups. CONCLUSION: Periacetabular osteotomy is recommended for dysplastic hips with deformed femoral head. A concomitant femoral osteotomy should be considered in hips with a severely deformed femoral head.

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.

Analysis of preoperative factors affecting the results of periacetabular osteotomy / 中国矫形外科杂志

10 points or if the progressing osteoarthritis was proved by the T nnis grade.And the remaining patients would join in the satisfied group.The differences of preoperative clinical and radiographic factors between unsatisfied group and satisfied group were identified.[Result]Ten hips in the unsatisfied group had significantly more WOMAC pain score(t=3.969,P

Clinical significance of three-dimensional CT reconstruction for periacetabular osteotomy / 上海第二医科大学学报

Objective To provide anatomical evidence for a safe osteotomy line and direction in periacetabular osteotomy.Methods The pelvic CT images of 18 adults were obtained.With the help of Mimics software,three-dimensional CT reconstruction was performed,and periacetabular osteotomy was simulated.The length of osteotomy lines on the ilium,ischium and iliac columna posterior was measured,and the relationship between osteotomy lines and anatomic landmarks was explored. Results The length of osteotomy lines on the ilium,ischium and iliac columna posterior was(50.96?7.09) mm,(36.46?5.92)mm and(55.28?6.42) mm,respectively.The angles between the osteotomy line on the ilium and that on the iliac columna posterior,between the osteotomy line on the ischium and that on the iliac columna posterior,and between the osteotomy line on the iliac columna posterior and quadrilateral surface were 120.21??5.96?,115.49??6.46? and 60.31??4.96?,respectively.And the real periacetabular osteotomy has been performed on the pelvic specimens for verification.The vertical distances between the ending point of osteotomy line on the ilium and iliopectineal line,between osteotomy line on the ischium and iliopectineal line,and between the osteotomy line on the iliac columna posterior and greater sciatic notch were(11.98?5.26) mm,(45.08?8.59) mm and(18.52?6.49) mm,respectively. Conclusion The length and angles of osteotomy lines in periacetabular osteotomy can be well measured by three-dimensional reconstruction,and the relationship between the osteotomy lines and anatomic landmarks can also be well displayed,which provides anatomical data for the clinical application of periacetabular osteotomy.

Bernese Periacetabular Osteotomy for Treatment of Acetabular Dysplasia / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiologic results of Bernese periacetabular osteotomy in treating acetabular dysplasia. MATERIALS AND METHODS: We evaluated the results of 24 Bernese periacetabular osteotomies performed in 21 patients (18 female, 3 male). The osteotomies were performed through an ilioinguinal approach in 20 cases, and dual (anterior and posterior) approaches in 4 cases. The mean age of the patients at the time of surgery was 23.4 years (range, 13.1-36 years). The average follow-up period was 26 months (range, 12-48 months). The Harris hip score was used for clinical evaluation. Radiological changes of acetabular angle, CE angle, acetabular depth, and femoral head coverage were measured. RESULTS: Clinically, the mean Harris hip score improved from 59.3 preoperatively to 88.3 postoperatively. All four radiological measurements improved significantly after surgery (Wilcoxon Rank Sum test, p<0.05). The following complications were noted: superficial skin infection (1 case), posterior column fracture (3 cases), temporary sciatic nerve symptoms (2 cases), and conversion to total hip arthroplasty (2 cases). CONCLUSION: Bernese periacetabular osteotomy is an effective surgical treatment for acetabular dysplasia in adults.

Incidence of Acetabular Retroversion in Dysplastic Hip / 대한정형외과학회잡지

PURPOSE: This study analysed the incidence and the degree of an acetabular retroversion in a dysplastic hip. MATERIALS AND METHODS: 28 cases of dysplastic hips, in whom the CE angle was <20 degrees, and 20 cases of control group with a normal CE angle were enrolled in this study. Four cuts among the CT images (most superior cut of the femoral head, middle cut of the proximal half, middle portion, and middle cut of the distal half of the femoral head) were used to measure the acetabular anteversion. RESULTS: In the control group, anteversion of four cuts (form the cranial to caudal) were observed with an average of 4.1, 10.3, 16.5, 19.7degrees, and there was one case with a retroversion. In the dysplastic hips, the average anteversion angles were 4.4, 11.0, 17.9, 20.8degrees, and 9 cases with retroversion were discovered. In all cases showing retroversion, an overlapping of the acetabular anterior and posterior wall (cross-over sign) was observed on the simple pelvis AP radiography. CONCLUSION: There was a 32% incidence of acetabular retroversion, which was much higher than the control group (p<0.05). Therefore, in order to prevent an over-correction of the retroversion, which may cause impingement, the presence and the amount of retroversion must be recognized using CT before performing a periacetabular osteotomy.

Bernese Periacetabular Osteotomy Using Dual Approaches for Hip Dysplasias / 대한정형외과학회잡지

PURPOSE: This study was aimed to evaluate the usefulness of the dual approaches used in Bernese periacetabular osteotomy for hip dysplasias, and also to comparatively evaluate the single anterior approach. MATERIALS AND METHODS: We performed a clinical and radiographic assessment of 15 cases (5 cases by the anterior approach and 10 cases by the dual approaches) of periacetabular osteotomy which had been followed up for more than 1 year. RESULTS: All patients had an improved Harris hip score, CE angle, acetabular angle, acetabular depth, femoral head coverage and medial shift of the femoral head. Gait improvement was confirmed by gait analysis. The mount of correction of the CE angle was more by the anterior approach than by the dual approaches, which was due to overcorrection. There were no statistical differences in the operation times or in the amounts of bleeding of the two approaches. Posterior column fractures occurred in 4 hips, which were due to blind osteotomies by the single approach, but none occurred after the dual approaches. CONCLUSION: We visualized all osteotomy sites and could perform the osteotomies easily and were able to decrease the number of complications associated with the dual approaches.