ABSTRACT
Chiari pelvic osteotomy (CPO) or medial displacement pelvic osteotomy is a surgical procedure of making a congruent shelf above intact hip joint by using the cancellous bone of ilium along with capsular interpositioning to contain the femoral head and bear weight. CPO is usually considered a salvage procedure indicated in patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. It has been widely performed for several decades but since 1990s number of CPO procedures has decreased because of use of other pelvic osteotomies, total hip arthroplasty (THA), ultrasound screening and narrowing indications for this procedure. However, CPO is not a historical procedure and it has viable indications in modern orthopaedic surgery, especially in patients who prefer joint-conservating procedure or in situations when THA is not feasible. Moreover, keeping the native hip as long as possible should be preferred modern orthopaedic approach. The Chiari osteotomy can produce excellent results in patients who have right indications and when other procedures are not suitable. On the other hand, there are several disadvantages of this procedure such as narrowing of the pelvis, shortening of the limb and risk of sciatic nerve palsy. With in-depth analysis of literature, we discuss indications for CPO, surgical technique of CPO, THA conversion rate after CPO, the interval from the CPO to THA and CPO survival rate.
ABSTRACT
INTRODUCTION: Acromioclavicular (AC) joint dislocations usually occur in a young active population as a result of a fall on the shoulder. Rockwood divided these dislocations into six types. Optimal treatment is still a matter of discussion. Many operative techniques have been developed, but the main choice is between open and minimally-invasive arthroscopic procedures. The aim of this study was to compare two different surgical methods on two groups of patients to find out which method is superior in terms of benefit to the patient. The methods were evaluated through objective and subjective scores, with a focus on complications and material costs. MATERIAL AND METHODS: A retrospective two-centre study was conducted in patients with acute AC joint dislocation Rockwood types III and V. The two methods conducted were an open procedure using K-wires combined with FiberTape(®) (Arthrex, Naples, USA) (Group 1) and an arthroscopic procedure using the TightRope System(®) (Arthrex, Naples, USA) (Group 2). Groups underwent procedures during a two-year period. Diagnosis was based on the clinical and radiographic examination of both AC joints. Surgical treatment and rehabilitation were performed. RESULTS: Sixteen patients were included in this study: Group 1 comprised 10 patients, all male, average age 41.6 years (range 17-64 years), Rockwood type III (eight patients) and Rockwood type V (two patients); Group 2 had six patients, one female and five male, average age 37.8 years (range 18-58 years), Rockwood type III (two patients) and Rockwood type V (four patients). Time from injury to surgery was shorter and patients needed less time to return to daily activities in Group 1. Duration of the surgical procedure was shorter in Group 2 compared with Group 1. Complications of each method were noted. According to the measured scores and operative outcome between dislocation Rockwood type III and V, no significant difference was found. Implant material used in Group 2 was 4.7 times more expensive than that used in Group 1. CONCLUSION: Both methods offer many advantages with satisfying evaluated scores. K-wires with FiberTape(®) offer a shorter period for complete recovery and a significantly more cost-effective outcome, whereas the TightRope System(®) offers shorter operative procedure, better cosmetic result and avoidance of intraoperative fluoroscopy.
