Acetabular Osteotomy Research Articles

Complete Redirectional Acetabular Osteotomy: Improving the Future for Patients with Trisomy 21?

Complete Redirectional Acetabular Osteotomy: Improving the Future for Patients with Trisomy 21?

Osteotomy around the Hip Joint

Hip joint preserving osteotomy surgery is the treatment of choice for young patients with early symptomatic structural abnormalities of the acetabulum and proximal femur. This is true even in the absence of severe secondary degenerative changes. These disorders can include hip instability from classic developmental dysplasia, post- traumatic acetabular dysplasia, hip impingement from retrotorsional acetabular deformities, or, rarely, post-traumatic problems. During the past 20 years, various techniques of acetabular and proximal femoral reorientation have evolved, making the procedure reliable, reproducible, and durable. In this report, the current indications and results of acetabular and proximal femoral osteotomies in patients with symptomatic acetabular structural problems will be discussed.

Quantitative evaluation of acetabular coverage by ACX software before and after rotational acetabular osteotomy

Quantitative evaluation of acetabular coverage by ACX software before and after rotational acetabular osteotomy

Instability of the Hip in Patients with Down Syndrome

The treatment of hip instability in patients with Down syndrome is challenging, and the literature provides little data to guide treatment. The purpose of the present study was to evaluate our results with complete redirectional acetabular osteotomy and to compare these results with our experience with other procedures. We retrospectively evaluated all patients with Down syndrome who underwent surgery for the treatment of gross hip instability or symptomatic acetabular dysplasia with or without subluxation. Medical records were reviewed for symptoms and demographic information. On the basis of the primary procedure, the patients were separated into Group A (periacetabular or triple osteotomy) or Group B (varus femoral osteotomy with or without incomplete acetabuloplasty [e.g., Dega osteotomy or shelf acetabuloplasty]). Preoperative and latest postoperative radiographs were used to compare the extrusion index, the lateral center-edge angle, the Tönnis angle, and the continuity of the Shenton line. Preoperative computed tomography (CT) scans were measured for acetabular version. We identified thirty-five hips (twenty-three patients), including twenty-five hips in Group A and ten in Group B. The mean age was 11.8 years, and the mean duration of follow-up was 5.3 years. Preoperatively, the acetabula were retroverted in both groups. Patients in Group A had worse initial hip pathology than those in Group B, as indicated by a higher mean extrusion index (50% compared with 33%; p = 0.06), a smaller center-edge angle (1° compared with 15°; p = 0.003), a larger Tönnis angle (21° compared with 10°; p = 0.001), and a smaller percentage of patients with an intact Shenton line (20% compared with 40%; p = 0.39). Most recent radiographs, however, showed superior results for Group A, including a lower mean extrusion index (10% compared with 29%; p < 0.0001), a larger center-edge angle (33° compared with 14°; p < 0.001), a smaller Tönnis angle (-1° compared with 10°; p < 0.001), and a larger percentage of patients with an intact Shenton line (88% compared with 70%; p = 0.32). Preoperatively, eighteen hips demonstrated gross instability: twelve were treated with either periacetabular osteotomy or triple innominate osteotomy, and all but one (92%) remained stable at the time of the latest follow-up. In contrast, six hips were treated with femoral osteotomy with or without incomplete acetabuloplasty, with only three (50%) remaining stable. Complete redirectional acetabular osteotomies are successful for stabilizing the hip and for correcting acetabular dysplasia in patients with Down syndrome.

Rotational Acetabular Osteotomy (RAO) in Young Patients to Control the Progress of Coxarthrosis

Rotational Acetabular Osteotomy (RAO) in Young Patients to Control the Progress of Coxarthrosis

Peri-acetabular rotational osteotomy with concomitant hip arthroscopy for treatment of hip dysplasia

Reconstructive acetabular osteotomy is a well established and effective procedure in the treatment of acetabular dysplasia. However, the dysplasia is frequently accompanied by intra-articular pathology such as labral tears. We intended to determine whether a concomitant hip arthroscopy with peri-acetabular rotational osteotomy could identify and treat intra-articular pathology associated with dysplasia and thereby produce a favourable outcome. We prospectively evaluated 43 consecutive hips treated by combined arthroscopy and acetabular osteotomy. Intra-operative arthroscopic examination revealed labral lesions in 38 hips. At a mean follow-up of 74 months (60 to 97) the mean Harris hip score improved from 72.4 to 94.0 (p < 0.001), as did all the radiological parameters (p < 0.001). Complications included penetration of the joint by the osteotome in one patient, a fracture of the posterior column in another and deep-vein thrombosis in one further patient. This combined surgical treatment gave good results in the medium term. We suggest that arthroscopy of the hip can be performed in conjunction with peri-acetabular osteotomy to provide good results in patients with symptomatic dysplasia of the hip, and the arthroscopic treatment of intra-articular pathology may alter the progression of osteoarthritis.

Enfermedad de Legg-Calvé-Perthes

Perthes’ disease is an idiopathic avascular necrosis of the proximal femoral epiphysis in children. Plain radiograph is the main diagnosis tool and is also used to classify the phase and the extent of the disease. Although it is a self-limited condition and its natural history is often benign, there are several factors that can worsen prognosis. Those factors are age, extent of the disease and some radiological signs and are useful to identify patients who will benefit the most from treatment. Adequate containment of the femoral head within the acetabulum resulting in a more spherical and congruous joint is the main goal of treatment, which is based mainly on surgical techniques, such as femoral or acetabular osteotomies. It has been shown that orthopaedic containment methods, like abduction orthosis, have not achieved better results.

Legg-Calvé-Perthes disease

Perthes’ disease is an idiopathic avascular necrosis of the proximal femoral epiphysis in children. Plain radiograph is the main diagnosis tool and is also used to classify the phase and the extent of the disease. Although it is a self-limited condition and its natural history is often benign, there are several factors that can worsen prognosis. Those factors are age, extent of the disease and some radiological signs and are useful to identify patients who will benefit the most from treatment. Adequate containment of the femoral head within the acetabulum resulting in a more spherical and congruous joint is the main goal of treatment, which is based mainly on surgical techniques, such as femoral or acetabular osteotomies. It has been shown that orthopaedic containment methods, like abduction orthosis, have not achieved better results.

The influence of femoroacetabular impingement to progression of osteoarthritis after rotational acetabular osteotomy

The influence of femoroacetabular impingement to progression of osteoarthritis after rotational acetabular osteotomy

Pubic/ischial stress fractures after eccentric rotational acetabular osteotomy

BackgroundAlthough there have been several reports on the complications of periacetabular osteotomy, stress fractures occurring in the pubic and ischial bones are less well recognised. The purpose of this study was to analyse the incidence of stress fracture, factors and treatment outcomes of stress fractures in the pubic/ischial bone after eccentric rotational acetabular osteotomy (ERAO). Materials and methodsWe examined 340 hips of 290 patients (male 35 hips, female 305 hips; mean age 42 years) with whom it was possible to conduct a minimum of 1 year of follow-up observations after ERAO. The following items were investigated: presence of a pubic/ischial stress fracture after surgery; gender; age; bilateral or unilateral osteoarthritis; height, weight and body mass index; preoperative and final stages of osteoarthritis of the hip; preoperative and final center-edge (CE) angle, acetabular head index and minimum joint space; preoperative and final Japan Orthopaedic Association score; and presence of a pubic discontinuity. We then compared cases with pubic/ischial stress fracture (fractured group) with those with no fracture (nonfractured group). For the fractured group, we also investigated the onset time of the fracture. ResultsThe fractured group consisted entirely of women with a mean age of 47 years, and comprised 10 (2.9%) of the 340 patient hips examined. A statistically significant difference was observed between the two groups in pubic discontinuities (fractured group 8/10, nonfractured group 16/330; P < 0.0001) and postoperative CE angle (fractured group; 43°, nonfractured group; 36°, P = 0.0338) according to univariate analysis. However, only the pubic discontinuity rate differed significantly between the groups according to multivariate analysis (P < 0.0001). In all cases, a pubic/ischial stress fracture occurred within 3 months after surgery, and all cases had bony union. Recurrent fracture occurred in only one hip. There was no difference in the clinical outcomes of the fractured and nonfractured groups at the time of final follow-up. ConclusionsThe patients with pubic discontinuities were significantly more susceptible to a pubic/ischial stress fracture after ERAO. The presence of a pubic/ischial stress fracture did not influence the clinical outcome.

A case of cartilage avulsion at the insertion of ligamentum capitis femoris after rotational acetabular osteotomy

A case of cartilage avulsion at the insertion of ligamentum capitis femoris after rotational acetabular osteotomy

A Case Report of Fibrous Dysplasia in an Acetabulum with Mild Hypoplasia of the Hip Treated with Bone Graft and Rotation Acetabular Osteotomy

A Case Report of Fibrous Dysplasia in an Acetabulum with Mild Hypoplasia of the Hip Treated with Bone Graft and Rotation Acetabular Osteotomy

A Clinical Experience of Rotational Acetabular Osteotomy

A Clinical Experience of Rotational Acetabular Osteotomy

Rotational Acetabular Osteotomy for Severely Advanced Coxarthrosis

Rotational Acetabular Osteotomy for Severely Advanced Coxarthrosis

Joint space wider than 2 mm is essential for an eccentric rotational acetabular osteotomy for adult hip dysplasia

BackgroundSatisfactory intermediate-term results after an eccentric rotational acetabular osteotomy (ERAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip (DDH) have been reported. The purpose of this study was to investigate whether a minimum joint space width (JSW) in patients with advanced osteoarthritis secondary to DDH influences intermediate-term clinical and radiographic outcomes after performing an ERAO. MethodsA total of 113 patients (116 hips) with a JSW of ≤3 mm were consecutively treated by ERAO for advanced osteoarthritis of the hip and then were followed for more than 5 years. Based on the preoperative JSW, the patients were divided into three groups: minimum JSW of ≤1 mm (JS1 group); JSW >1 mm but ≤2 mm (JS2 group); JSW > 2 mm but ≤3 mm (JS3 group). The average ages of the JS1, JS2, and JS3 patients were 40, 44, and 43 years, respectively. The average follow-up period was 10.6 years. ResultsOverall conversion to total hip arthroplasty (THA) was performed in 14 joints. According to a Kaplan-Meier survivorship analysis at 15 years after the index operation, 96% of the patients with a JSW of >2 mm (JS3 group) did not require conversion to THA. ConclusionsA JSW of >2 mm before surgery is considered essential to obtain an excellent intermediate-term result following performance of an ERAO.

Crossover sign after rotational acetabular osteotomy for dysplasia of the hip

BackgroundThis study was performed to evaluate whether the radiographic crossover sign influences the painful femoroacetabular impingement or the radiographic progression of osteoarthritis after rotational acetabular osteotomy (RAO). MethodsA total of 104 patients (115 hips) with preosteoarthritis (pre-OA) or early-stage OA of the hip due to dysplasia underwent RAO. Their mean age at the time of surgery was 34.7 years. The mean follow-up period was 13 years. Clinical follow-up was performed with the system of Merle d’Aubigne, and the impingement sign was evaluated. Radiographic analyses included the center-edge angle, acetabular roof angle, head lateralization index (HLI), joint congruency, crossover sign, posterior wall sign, acetabular index of depth to width, pistol grip deformity, and femoral head/femoral neck ratio. ResultsThe mean clinical score improved significantly from 14.6 preoperatively to 17.0 at follow-up. The impingement sign at follow-up was observed in 14 hips (12.2%). The center-edge angle, acetabular roof angle, and head lateralization index (HLI) improved significantly after surgery. The crossover sign was observed in 8 hips (7.0%) preoperatively and in 49 hips (42.6%) postoperatively. The posterior wall sign was observed in 70 hips (60.9%) preoperatively and in 73 hips (63.5%) postoperatively. The impingement sign after RAO was positive significantly in the postoperative crossover sign-positive hips. Radiographic progression of OA was observed in 11 hips (crossover sign was positive in 7 hips and negative in 4 hips). The only factors significantly associated with radiographic progression after RAO were fair postoperative joint congruency and age at surgery. ConclusionsAlthough there was no significant radiographic progression of OA despite significant retroversion, anterior impingement and radiographic crossover sign after RAO are should be checked during the procedure. The goal of RAO should be correct alignment of the acetabulum including a correct version with a negative crossover sign.

Acetabular Medial Wall Displacement Osteotomy in Total Hip Arthroplasty for Dysplastic Hips

Purpose: This study evaluated the results of acetabular medial wall osteotomy to reconstruct the acetabulum in dysplastic hip during total hip arthroplasty. Materials and Methods: We clinically and radiologically evaluated 30 hips of 30 patients with secondary hip osteoarthritis caused by congenital hip dislocation or acetabular dysplasia who underwent total hip arthroplasty (THA) between March 1999 and October 2002. The average age of subjects was 46.5 years(17 to 73 years), and the mean follow-up period was 5 years(5.3 to 8.7 years). In 26 cases, a cementless hemispherical acetabular cup was inserted in the true acetabulum; in 4 cases a reinforced ring was inserted. Only 2 hips needed structural bone grafting. Results: The average Harris hip score improved from 56.3 points preoperatively to 93.2 points at the last follow up. Radiographic analysis revealed no aseptic loosening or radiolucent line, and showed stable bony fixation at the true acetabulum. The mean thickness of the medial acetabular wall postoperative was 20.5 mm(10 to 36 mm). Bone union of the medial wall was observed at a mean of four months postoperatively. Conclusion: Acetabular medial wall osteotomy can maintain the integrity of the acetabular medial wall while achieving enhanced acetabular coverage and more normal hip biomechanics.

A comparison of the treatment of DDH in the older children by femoral shortening with a) acetabular shelf and b) innominate osteotomy plus shelf

To examine the surgical outcome of 2 different techniques used in the treatment of developmental dislocation of the hip with delayed diagnosis. Materials and methods: The patients were divided into 2 groups based on the technique applied: 21 hips of 18 patients were included in Group 1 and 20 hips of 16 patients were included in Group 2. Initially, all the patients were subjected to femoral osteotomy, shortening, varization and derotation. In Group 1, additionally extra-articular grafting was performed for acetabulum and in Group 2, acetabular osteotomy and extraarticular grafting were performed. The mean age of Group 1 was 8 years, and the mean age of Group 2 was 7 years. Results: The results were evaluated radiologically and clinically. The mean follow-up time was 4 years. In the patients under 7 years of age, successful results were obtained in both groups. Of 7 patients with poor outcome, 6 were older than 7 years of age. Conclusion: The surgical treatment of childhood developmental dislocation of the hip with delayed diagnosis is difficult. However, it can be concluded that, in patients 7 years old or younger with a diagnosis of developmental hip dislocation, the 2 techniques described here are effective.

Combined Preoperative Autologous Blood Donation and Intra-Operative Cell Salvage for Hip Surgery

To review records of 161 consecutive hip surgery patients for whom preoperative autologous blood donation (PABD) was used in combination with intra-operative cell salvage (ICS). 114 women and 14 men aged 41 to 86 (mean, 64) years underwent 135 primary total hip arthroplasties (THAs), whereas 19 women and 7 men aged 16 to 52 (mean, 35) years underwent 26 rotational acetabular osteotomies (RAOs). Two or 3 weeks before the operation, patients deposited one unit (400 ml) of blood weekly, so long as their haemoglobin levels exceeded 110 g/l (if they had osteoarthritis) or 100 g/l (if they had rheumatoid arthritis). Patients were given oral ferrous sulphate, lactated Ringer's solution, and recombinant human erythropoietin. 800 and 1200 ml of blood were deposited for patients undergoing THA and RAO, respectively. Intra-operatively, ICS was carried out using a continuous autotransfusion system. The blood from ICS was transfused first, and then the blood from PABD was transfused during the latter half of the operation. By combining PABD and ICS, homologous blood transfusion was avoided in all patients, even in those with unexpected massive bleeding during surgery. In 3 patients, one unit of deposited autologous blood was discarded, because they showed no sign of anaemia. The mean total blood loss was almost 1.5 times higher in RAO than in THA patients (1095 vs 1550 ml). In the THA and RAO patients respectively, the mean amount of ICS was 181 and 210 ml, whereas the mean total blood transfusion volume was 975 and 1394 ml. No complications (including infection) related to autologous blood transfusion were observed during PABD, the surgery or the postoperative period. Homologous blood transfusion was avoided with the use of PABD and ICS. Preoperative donation of 800 and 1200 ml of blood (combined with ICS) seemed optimal, as only 3 units of blood were discarded.

Juzentaihoto (TJ-48), a traditional Japanese herbal medicine, influences hemoglobin recovery during preoperative autologous blood donation and after hip surgery

Preoperative autologous blood donation is a widely used alternative to allogenic transfusion in hip surgery. However, it has been reported that autologous blood donation may induce preoperative anemia. Juzentaihoto (TJ-48) (Tsumura Co., Tokyo, Japan) is a Japanese herbal medicine that has been used to alleviate anemia. We investigated the effect of TJ-48 on anemia in the perioperative period. 18 hips of 18 female patients who underwent total hip arthroplasty or rotational acetabular osteotomy (RAO) were divided into two groups. Group A consisted of 9 hips of 9 patients who were treated with TJ-48 at a dose of 7.5 g per day from 21 days before surgery to the day before surgery. Group B consisted of 9 hips of 9 patients who did not take TJ-48. Preoperative autologous blood donation was performed 21, 14 and 7 days before surgery. All patients deposited 400 ml each time for a total of 1,200 ml. Hemoglobin level was recorded on preoperative Days 21, 14 and 7 and postoperative Days 1, 4, 7 and 14. During the preoperative period, repeated measures ANOVA showed a significant difference between the two groups in hemoglobin level (p = 0.04). Despite the lack of TJ-48 after surgery, the rate of hemoglobin decline in Group A was less than in Group B at all examination times. No patients with TJ-48 experienced side effects, including gastrointestinal symptoms and unusual laboratory data. TJ-48 is useful for treating anemia during preoperative autologous donation.