Abstract
Background. Pelvic osteotomies are widely used for treatment of young active patients with developmental dysplasia of the hip (DDH) Type I according to the Crowe or type A according to Hartofilakidis classifications and the absence of severe degenerative cartilage lesions. Nowadays, Ganz periacetabular osteotomy (PAO) is the most common choice of surgeons around the world in treatment of such patients.The aim of the study was to evaluate the radiological and functional results of Ganz periacetabular osteotomy in patients with DDH.Material and Methods. A single-center retrospective analysis of 49 Ganz PAO was performed in 43 patients aged 36±9 years. The radiological evaluation criteria were Wiberg (AW), Lequesne (AL), Tonnis (AT) angles, and joint medialization. The results of treatment were evaluated using the Harris scale, iHOT-12, and VAS before treatment and 1 year after, the presence of complications was also monitored.Results. The average follow-up period was 35±15 months (from 1.0 to 6.9 years). Radiological parameters improved after surgery compared to preoperative ones: AW +19.9° (17.1° vs. 37.0°), AT -11.5° (19.9° vs. 8.4°), AL +14.1° (25.1° vs. 39.2°), joint medialization -5.5 mm (14.3 mm vs. 8.8 mm) (p0.001). Functional results and quality of life of patients also improved: the Harris scale +35.6 points (47 vs 83 points), iHOT-12 +40.9 points (44 vs 85 points), pain level -2.8 points (5 vs 2 points) (p0.001). Various complications developed in 20 out of 49 cases (40.8%). Neurological complications were resolved conservatively (22.4%). A direct correlation was evaluated between the surgical treatment of DDH in childhood and the development of neurological complications after PAO (R = 0.76; p0.001). In 9 cases out of 49 (18.4%), revision surgery was required: in 3 — total hip replacement, in 2 — reorientation of the acetabulum, in 4 — arthroscopic fixation of the anterior articular lip. In 93.9% of cases native hip joint surfaces were preserved.Conclusion. Ganz PAO has good reconstructive capabilities and sufficient efficiency. The operation allows to restore the coverage of the femoral head with the acetabulum, delays total hip replacement and provides improved functional results.
Highlights
Pelvic osteotomies are widely used for treatment of young active patients with developmental dysplasia of the hip (DDH) Type I according to the Crowe or type A according to Hartofilakidis classifications and the absence of severe degenerative cartilage lesions
Рентгенологические исследования таза и тазобедренного сустава (ТБС) проводили в трех проекциях: передне-задней, боковой и наружной косой проекции с поворотом таза 65°
Ricciardi B.F., Fields K.G., Wentzel C., Nawabi D.H., Kelly B.T., Sink E.L. Complications and short-term patient outcomes of periacetabular osteotomy for symptomatic mild hip dysplasia
Summary
Критерии включения: дисплазия ТБС I типа по классификации Crowe или типа А по Hartofilakidis, отсутствие тяжелых дегенеративных изменений ТБС, возраст от 18 лет. Критерии невключения: наличие противопоказаний к оперативному лечению, несогласие пациента на лечение по предложенной методике, невозможность проведения контрольных осмотров после выписки из стационара. Показаниями к ПАО таза по Ganz являлись: наличие дисплазии ТБС I типа по классификации Crowe или типа А по Hartofilakidis, сопровождающейся болевым синдромом; межсуставное пространство более 3 мм, сгибание бедра >110°, внутренняя ротация бедра
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