Preliminary results of treatment of complex hip dysplasia with combined periacetabular and intertrochanteric osteotomies

Abstract

Objective To detect the preliminary results of combined periacetabular and intertrochanteric osteotomies for complex hip dysplasia. Methods From January 2006 to August 2011, 23 patients (25 hips) with complex hip dysplasia were treated with combined periacetabular and intertrochanteric osteotomies (ITO). Valgus ITO was performed on 2 hips and varus ITO on others. The average age of patients at the time of index procedure was 20.5± 3.9 years (range: 15 to 26). The hip pain period before surgery varied from 5 to 24 months (mean 11±4.7 months). The Shenton's line was broken in every hip and the mean preoperative lateral central edge angle (LCEA) was 5.6°±4.6°. The average preoperative femoral neck-shaft (CCD) angles were 158°±3.2° and 110° in 23 valgus hips and both of two varus hips respectively. The preoperative Harris hip score was 76.7±3.7. According to Tonnis osteoarthritis grades, there were 7 hips at grade 0, 12 hips at grade Ⅰ and 6 hips at grade Ⅱ. Results The mean followup period was 40±18 months (range: 12 to 78). The CCD angle (130°±2.1°), LCEA (28.6°±2.9°) and Harris hip score (90.8±3.3) were all improved postoperatively, whereas no progression was found in preoperative Tonnis grades. The postoperative Harris hip scores were excellent in 17 hips and good in 8 hips. The Tonnis osteoarthritis grades were grade 0 in 6 hips, grade Ⅰ in 11 hips and grade Ⅱ in 8 hips. There were six cases with lateral femoral cutaneous nerve injury, three cases with limp and two cases with broken Shenton's line. Neither femoral head necrosis nor bone nonunion was found in this study. Conclusion Satisfactory preliminary results could be obtained through combined periacetabular and intertrochanteric osteotomies among patients with complex hip dysplasia. The risk of femoral head necrosis and bone nonunion was low. Key words: Hip dislocation, congenital; Acetabulum; Osteotomy