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.

Periacetabular Rotational Osteotomy in Hip Dysplasia: Short Term Follow up Result / 대한정형외과학회잡지

PURPOSE: To evaluate the short term results of a periacetabular rotational osteotomy in early and moderate osteoarthritis of hip dysplasia by comparing the clinical findings and radiological measurements. MATERIALS AND METHODS: Thirty-six cases (34 patients) who received periacetabular rotational osteotomy for hip dysplasia with pain and could be followed up for more than one year were reviewed. The clinical findings were evaluated by the range of motion and HHS. The radiological measurements were evaluated using the center edge angle (CE angle), Sharp angle, acetabular-head index (A-H index) and Tonnis grade. RESULTS: The average Harris hip score improved from 79.4 points (60 to 89 points) to 95.1 points (82 to 100 points). The average range of motion did not change significantly. The mean CE angle increased from 7.1degrees (-7degrees to 19degrees) to 33.8degrees (27degrees to 44degrees), the mean sharp angle increased from 43.5degrees (26degrees to 53degrees) to 39.7degrees (30degrees to 49degrees), the mean A-H index increased from 56% (34% to 72%) to 90% (73% to 99%). The Tonnis grade had remained unchanged in 25 cases, improved in 9, and worsened in two. One case underwent total hip arthroplasty. CONCLUSION: The periacetabular rotational osteotomy is the preferred method for treating hip dyaplasia and preventing secondary osteoarthritis. However, a skillful technique is mandatory.