Periacetabular osteotomy through ilioinguinal approach for the treatment of developmental dysplasia of the hip in middle-aged adults / 中华骨科杂志

ABSTRACT

Objective To investigate the indications and mid-term outcomes of periacetabular osteotomy through ilioinguinal approach for developmental dysplasia of the hip (DDH) in middle-aged (40-50years old) adult patients.Methods Data of 10 adult patients who had undergone periacetabular osteotomies through ilioinguinal approach for DDH from August 2005 to February 2010 were retrospectively analyzed.There were 7 females and 3 males,aged from 40 to 47 years (average,42 years).Bilateral hips were involved in 3 patients,and unilateral hip was involved in 7 patients.Before this hospitalization,1 patient had received Chari osteotomy,and 1 had received hip-shelf procedure.According to the T(o)nnis classification,3 hips were classified as Grade 0,5 as Grade Ⅰ and 2 as Grade Ⅱ.The Shenton line was discontinuous in 6 hips.The average lateral center-edge angle was 3.50°±4.88°; the average anterior center-edge angle was 1.80°±5.07°; the average acetabular index angle was 18.20°±3.01°; the average femoral head extrusion index was 31.30％±4.37％; the average Harris hip score was 67.40±7.75.Changes of the indexes mentioned above were observed during the whole period of follow-up.Results All patients were followed up for 10 to 76 months (average,37 months).The T(o)nnis grade improved in 2 cases,from preoperative Grade Ⅰ and Grade Ⅱ to Grade 0 and Grade Ⅰ at final follow-up,respectively.At final follow-up,the Shenton line was discontinuous in 2 hips; the average lateral center-edge angle improved to 30.40°±3.31°,the average anterior center-edge angle improved to 29.50°±3.03°,the average acetabular index angle decreased to 4.50°±2.55°,the average femoral head extrusion index decreased to 9.90％±4.33％; the average Harris hip score increased to 84.10±4.07.The major complications included 3 cases of lateral femoral cutaneous nerve palsy which recovered in 4 to 6 months,and 1 case of iliac fossa hematoma which disappeared in 2 weeks.Conclusion With more strict surgery indication and more meticulous manipulation,periacetabular osteotomy through ilioinguinal approach can achieve satisfactory results in the treatment of DDH in middle-aged adults,which can increase hip joint congruence,relieve hip symptom and delay progression of osteoarthritis.