Treatment of acetabular dysplasia by triple pelvic osteotomy and its short-term results

Abstract

We evaluated the effect of triple pelvic osteotomy on acetabular coverage and its clinical implications by clinical and radiographic parameters in patients with acetabular dysplasia. Triple pelvic osteotomy was performed in 21 hips of 19 patients (13 females, 6 males; mean age during operation 16.3 years; range 8 to 32 years). Acetabular dysplasia was bilateral in two, and unilateral in 17 patients. Etiology was developmental dysplasia of the hip in 12 patients, Legg-Calve-Perthes disease in five patients, and diplegic and quadriplegic cerebral palsy in two patients, respectively. The patients were clinically evaluated by the modified Merle d'Aubigne-Postel system, and radiographic assessments were made using nine parameters. The mean follow-up period was 27.7 months (range 14 to 60 months). According to the modified Merle d'Aubigne-Postel system, preoperative and postoperative clinical scores were 13.14 and 15.29, respectively (p<0.001). The Trendelenburg test was positive in all (94.7%) but one patient preoperatively. At final follow-up, it was positive in six hips (28.6%), delayed positive in 12 hips (57.1%), and negative in three hips (14.3%). Of radiographical parameters, the mean corrections obtained in the center-edge angle, femoral head coverage, acetabular angle, and acetabular index angle were 21.6 degrees (p<0.05), 18% (p<0.05), 14.5 degrees (p<0.05), and 16.4 degrees (p<0.05), respectively, with an increase in lateralization (1.7 mm; p<0.05) and a decrease in cranialization (3.8 mm; p>0.05). The ratio of acetabular depth to width remained unchanged (p>0.05). Triple pelvic osteotomy is successful in correcting biomechanics of the hip joint in most of the patients with acetabular dysplasia.