Periacetabular osteotomy for the treatment of developmental dysplasia of the hip in adults

Abstract

Objective To study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). Methods Twenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years (range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.Results All patients were followed up for average 4.5 years (range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy (7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . Conclusion Periacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis. Key words: Hip dislocation, congenital; Osteotomy; Acetabulum; Osteoarthritis, hip