Clinical and radiographic evaluation of double pelvic osteotomy to treat canine hip dysplasia / Avaliação clínica e radiográfica da osteotomia dupla da pelve no tratamento da displasia coxofemoral canina

ABSTRACT: The purpose of this study was to describe our initial experience with double pelvic osteotomy (DPO) in young dogs affected by hip dysplasia (HD) and to report their postoperative outcome. Seven dogs (four females and three males) were included in our study with mean age 8.3 (±1.7) months, and mean body weight 29.5 (±7.4)Kg. Breeds involved were: Rottweiler (n = 1), Labrador Retriever (n = 3), Golden Retriever (n = 1), Great Dane (n=1) and São Miguel Cattle Dog (n = 1). The most common history complaints were: pelvic limb lameness and pain at hip extension and hip abduction. All surgical procedures consisted of osteotomy of the ilium and pubis, acetabular ventroversion and iliac stabilization with a customized bone plate with seven screws, four screws placed at the cranial fragment and the remaining three in the caudal aspect. Average surgical time was 65.8 (±10.4) minutes and median follow-up assessment was 68 (±15) days. Fracture healing was observed within mean period of 26.3 (±8.9) days. Six patients (86%) had satisfactory outcome and one patient didn't improve after surgery and had to undergo a total hip replacement. Our results showed that DPO is an effective treatment for HD due to the preservation of pelvic geometry and low postoperative morbidity. Since it is a recent technique, further studies are recommended.

RESUMO: O objetivo do estudo é a descrição da osteotomia dupla da pelve (ODP) em pacientes com displasia coxofemoral (DCF) e relatar a evolução pós-operatória. As raças acometidas foram: Rottweiler (n=1), Labrador (n=3), Golden Retriver (n=1), Dogue alemão (n=1) e Fila de São Miguel (n=1). O total foi de sete animais, sendo três machos e quatro fêmeas; a média de idade e peso dos cães foi de 8,3±1,7 meses e 29,5±7,4Kg, respectivamente. As queixas iniciais mais comuns antes da cirurgia foram: claudicação em membro pélvico e dor à extensão e abdução do quadril. A cirurgia constou em realizar a osteotomia do ílio e púbis, rotacão axial do acetábulo sobre a cabeça do fêmur e osteossíntese do ílio com a utilização de placa fixada com sete parafusos, quatro destes no segmento cranial e três no segmento caudal. Após a cirurgia um animal não apresentou melhora do quadro, caracterizado por agravamento da subluxação coxofemoral, sendo submetido à prótese total de quadril. O tempo médio de cirurgia foi de 65,8±10,4 minutos e o período de acompanhamento médio pós operatório foi de 68,0±15,0dias, visibilizando a reação osteoproliferativa no foco de osteotomia ilíaca em um período médio de 26,3±8,9 dias. Dos sete animais envolvidos no estudo, seis tiveram recuperação satisfatória após o primeiro procedimento no período avaliado. Os resultados apontam a técnica de OPD como procedimento eficiente no tratamento de DCF devido à preservação da geometria pélvica e baixa morbidade pós-operatória. Por se tratar de uma recente técnica, ainda pouco difundida, é interessante a realização de maiores estudos.

Rotational Acetabular Osteotomy

Hip dysplasia is the most common cause of secondary osteoarthritis (OA). To prevent the early onset of secondary OA, Nishio's transposition osteotomy, Steel's triple osteotomy, Eppright's dial osteotomy, Wagner's spherical acetabular osteotomy, Tagawa's rotational acetabular osteotomy (RAO), and Ganz' periacetabular osteotomy (PAO) have been proposed. PAO and RAO are now commonly used in surgical treatment of symptomatic acetabular dysplasia in Europe, North America, and Asia. The aim of this paper is to present the followings: the patient selection criteria for RAO; the surgical technique of RAO; the long-term outcome of RAO; and the future perspectives.

Pelvic Osteotomy in Adults / 대한정형외과학회잡지

Pelvic osteotomy is a surgery for correcting acetabular deformity, which causes incomplete coverage of the femoral head or biomechanically abnormal load to the hip joint. Pelvic osteotomy can be divided into two categories: reconstructive or realignment osteotomy and salvage osteotomy. Reconstructive osteotomy can be performed to correct the dysplastic hip with good congruency, and include most pelvic osteotomies, except Chiari osteotomy. Among these, Bernese osteotomy, rotational acetabular osteotomy, and periacetabular rotational osteotomy are commonly being used. Salvage osteotomy, which include Chiari osteotomy only, can be performed to increase the coverage of the femoral head of hip joint with joint incongruency due to the severely deformed femoral head and acetabulum or advanced osteoarthritis. Chiari osteotomy is a kind of arthroplasty reducing the pressure applied to the head, and increasing the bone coverage on the upper part of the femoral head. It is effective in reducing hip pain and slowing degenerative changes; however, as the surface is covered by fibrous cartilage, it is vulnerable to degenerative changes. The pelvic osteotomy is a very important and useful surgical technique to preserve joints, despite being a difficult procedure that is technically demanding.

Analysis of outcomes of one-stage operation for treatment of late-diagnosed developmental dysplasia of hip / 中华外科杂志

Objective@#To evaluate and identify the middle-term results of one-stage open reduction of patients in late-diagnosed developmental dysplasia of the hip, and to explore the best age group for treatment.@*Methods@#A total number of 311 patients (390 hips) with LDDH in Department of Pediatric Orthopaedic of Anhui Provincial Children′s Hospital from June 2006 to December 2010 were retrospectively reviewed. The patients were divided into 3 groups according to age at the start of surgical treatment: 1.5-2.5 years, 2.5-7.0 years and >7.0 years. There were 11 males and 71 females in group of 1.5-2.5 years with average age of (2.1±0.3) years; There were 29 males and 165 females in group of 2.5-7.0 years with average age of (4.4±0.4) years; There were 8 males and 33 females in group >7.0 years with average age of (9.2±1.4) years. The last clinical and radiographic outcomes, complications and avascular necrosis (AVN) of the femoral head were evaluated and compared among the three groups. ANOVA and Pearson′s χ2 statistic were used to analyze data.@*Results@#Among the three groups, there were no statistically differences in gender, acetabular index, different sides and follow-up time(all P>0.05), there was significant difference in Tönnis grade(χ2=21.410, P<0.01). There were 77.4% of patients showed an excellent or good result according to McKay′s clinical classification and 82.6%(390 hips) according to Severin′s radiological classification. A total of 28.5% of all hips had a poor outcome according to the Kalamchi and MacEwen classification (grade Ⅱ to Ⅳ) for AVN. Radiographic(χ2=78.860, P<0.01) and AVN(χ2=14.756, P=0.001) results (poorest in group of >7.0 years and best in group of 2.5-7.0 years) between three groups had statistically differences. Furthermore, clinical outcomes in group of >7.0 years was significantly lowest than groups of 1.5-2.5 years or 2.5-7.0 years, there was no significant differences between groups of 1.5-2.5 years and 2.5-7.0 years(χ2=1.503, P=0.682). The incidence of redislocation and residual acetabular dysplasia in Tönnis grade Ⅱ or Ⅲ hip dislocation(85.0%, 17 hips) was significantly higher (χ2=4.440, P=0.035).@*Conclusion@#One-stage treatment of LDDH had good outcome in 1.5 to 7.0 years patients, the best age are 2.5-7.0 years.

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.

The Use of Xenograft ( Lubboc(r)) for Pelvic Osteotomy in Children / 대한정형외과학회잡지

The purpose of this study is to present a novel method of harvesting autogenous bone graft and to analyze the behavior of xenograft used for pelvic osteotomy in young children. Twenty hips of eighteen patients underwent pelvic osteotomies using xenograft (Lubhoc) from Sep. 1993 to Jun. 1996. In fitteen hips, we harvested autogenous bone avoiding damage to the chondroapophysis of iliac crest and t'illed the donor site with the xenograft. It supplemented the autogenous bone at the osteotomy site in eleven hips, and was used as a wedge without autogenous hone in five hips. During the followup, no growth disturbance of iliac crest was found. The xenograft incorporation was satisfactory at the graft donor sites and the osteotomy sites where it supplemented the autogenous bone, however, unsatistactory at the osteotomy sites where it was used alone. Our novel method of harvesting bone graft from young pelvis may help prevent growth disturbance of lilac crest, and Luhhoc is useful as space-filler of donor site and suppiementary to the autograft in pelvic osteotomy of young children.

Chiari Pelvic Osteotomy in Children and Adolescent / 대한정형외과학회잡지

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.

The use of self-reinforced absorbable(SR-PLLA) rods for cutting pelvis by Chiari way to cure Perthes disease / 重庆医科大学学报

Objective:To evaluate the results of treating Perthes disease by pelvic osteotomy and internal fixation with self-reinforced absorbable (SR-PLLA) rods. Methods:50 cases of Perthes disease(53 hips) were involved. According to Herring classification, there were 16 hips of type B ?5 hips of type B/C and 32 hips of type C. All patients were treated by pelvic osteotomy(Chiari)and internal fixation with self-reinforced absorbable (SR-PLLA) rods. Results:All cases were followed up for 2 months to 18 months, with an average of 6 months. All cutting bone was healed. There was no bacterial wound infection or sterile inflammatory foreign-body reaction. Failure of fixation was only occurred in one case. Bone union was seen 6 weeks to 12 weeks, with an average of 8 weeks. All patients restored normal hip joint function and had no pain. Conclusion:This operative technique is simple and can achieve reliable fixation. It can improve bone healing with a reduced healing time and avoid secondary a removal operation. This surgical procedure is an effective way to treat cutting pelvis in Perthes disease.