Ilizarov Technique with Proximal Femoral and Triple Pelvic Osteotomy for the Treatment of Adolescent Developmental Dysplasia of the Hip.

Abstract

Objective The significance of pelvic osteotomies in developed coxarthrosis is still disputable. Some authors believe that incongruence and early osteoarthritis of the articular surfaces are contraindications for joint-preserving surgery and will stimulate further progression. The opposite view is that triple pelvic osteotomy can be an alternative to early joint replacement. The present study reports the mid to long term results of adolescent patients with developed coxarthrosis treated by proximal femoral and triple pelvic osteotomies and fixed by the Ilizarov technique. Methods A retrospective review between 2002 and 2014 of the treatment of 26 patients with coxarthrosis due to developmental dysplasia of the hip (DDH). The sample was composed of 22 female and 4 male subjects with a mean age at operation of 14.7 years (range: 12–18 years) and mean follow-up of 5.9 years (range: 3–13 years). Results The initial functional results according to the Merle d'Aubigné and Postel criteria were: pain – 4.3 ± 0.05 points; range of motion – 3.6 ± 0.3 points; and gait – 4 ± 0.15 points. The average index of the weight bearing zone (WBZ) was of 38.7° ± 2.721°. The acetabular coefficient (AC) was of 162 ± 6.8, the center–edge angle (CEA) of Wiberg was of 3° ± 0.2°. The outcomes were followed up from 3 to 13 years. At the final follow-up, the radiographic outcomes showed that the value of the WBZ decreased to 8.2° ± 1.293° (0–15°), and that the AC increased to 249 ± 12.05. The average neck–shaft angle (NSA) was of 115° ± 4°, the articulo-trochanteric distance (ATD) was of 8,5 ± 1,5 mm, and the CEA of Wiberg was of 28° ± 1.6°) at the final follow-up. The distribution of the joints according to Tönnis et al was: grade I – 17 joints; grade II – 8 joints; and grade III – 1 joint. The outcomes were good for 14 patients (54%), fair for 10 patients (34.5%), and poor for 2 (11.5%) patients. Conclusion The treatment of adolescent hip dysplasia requires a proper assessment of the degree of dysplasia and the surgery needed to redirect pelvic components to achieve suitable conditions for hip remodeling, and our mid- to long-term results showed very good outcomes when applying these principles using the Ilizarov technique.