Pelvic Support Osteotomy Research Articles

I s pelvic support osteotomy (PSO) suitable for ordinary high-riding hip dysplasia?

Pelvic support osteotomy (PSO) is regarded to provide pelvic stability and improve abductor function to delay or even avoid total hip arthroplasty (THA) in young patients with high-riding hip dysplasia. However, some of these patients eventually have to undergo THA. Because of the double-angulation deformity of the femur after PSO, subsequent THA is challenging. This study aimed to analyze whether PSO surgery is suitable for high-riding hip dysplasia and summarize orthopaedic strategy during THA for patients with previous PSO. This case-control study included eight cases of THA for high-riding hip dysplasia patients with previous PSO (study group) and 24 cases of high-riding hip dysplasia patients without any hip surgical therapy (control group) by a 1:3 match (from May 2018 to January 2022). We compared demographics and joint function before and after THA between two groups and recorded all patients' preoperative imaging data, surgical procedures, postoperative imaging data, and complications. The surgical techniques for patients with previous PSO were highlighted. There was no statistical difference between the two groups in demographic (p > 0.05). The study group had worse hip Harris score (HHS), range of motion (ROM), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (p < 0.05) compared with the control group before THA. All patients had concurrent THA and osteotomy at the proximal femur, but the study group experienced longer operation time (p = 0.047) with more blood loss (p = 0.027) and higher complication rate compared with the control group (p = 0.009). At the last follow-up, the study group's HHS, ROM, VAS, and WOMAC were still worse than those in the control group. PSO did not improve the joint function of high-riding hip dysplasia patients but brought challenges to subsequent THA and affected the surgical outcomes. In short, we suggested that PSO is unsuitable for routine high-riding hip dysplasia patients.

Modification of Pelvic Support Osteotomy Technique in Patients with Sequelae of Hip Dysplasia: A Case Series.

The management of hip dislocation in patients older than 9 years of age is a challenge in terms of deciding which is the best treatment course to follow since the main sequelae are as follows: pain, discrepancy in the length of the pelvic extremities and lame gait, with the consequent disability for activities of daily living. In Ho Choi, Thabet A mention limited treatment options, including total hip arthroplasty and hip arthrodesis. These options have their benefits and limitations. The pelvic support osteotomy initially indicated for the treatment of septic arthritis of the hip and performed for the first time by Bavoier in 1838 and modified in 1970 by Ilizarov aims to improve the aforementioned sequelae. These cases report showed us the functional improvement with the treatment of dislocated hip dysplasia with pelvic support osteotomy with monolateral fixator and the 2nd osteotomy 4 cm distal to the hip. This was corroborated through the application of the modified Harris test. A series of six female Mexican adolescent patients from 11 to 17 years of age who come to the clinic due to long-standing pain symptoms in the coxofemoral joint, three patients in the right and three in the left hip when walking. All were treated with pelvic support osteotomy. The six patients continued with mild positive Trendelenburg but all of them diminished the discrepancy in the pelvic extremities, the mobility arcs were preserved and pain was suppressed in all. The modified Harris test showed increased scores (103.3%) after the surgery. There was just a minor complication in a patient, and it was resolved with surgical lavage. The modifications in the technique, monolateral fixator and second osteotomy 4 cm from the first one, allowed our patients to present functional improvement at the hip, which was assessed with the modified Harris scale. Patients achieved independent walking without pain and Trendelenburg less evident. The changes we found in our patients are evidence of the goodness and effectiveness of this type of osteotomy in patients older than 9 years of age, to improve the function of the hip.

Is arthroplasty inevitable after Ilizarov hip reconstruction of unstable hip joints in adolescents and young adults? Long-Term Evaluation of 136 Cases

Introduction Whereas hip joint destroying trauma and diseases are difficult situations, the problem is more complex when it is complicated by hip instability. This could be a sequel of several hip affections such as trauma, septic or tuberculous arthritis, neglected developmental dysplasia of the hip, postoperative conditions, and neurologic pathologies (cerebral palsy, myelomeningocele, poliomyelitis). Purpose The purpose of this study is to evaluate long-term radiographic and clinical outcomes of the Ilizarov hip reconstruction for the treatment of painful and unstable hips in adolescents and young adults. Materials and methods The study included 136 patients with an average age of 18.3 years (range, 6 to 34 years); 75 patients were males (55.1%) and 61 females (44.9%). The primary causes of the hip instability were untreated or unsuccessfully treated cases of septic arthritis (40 cases; 29.4 %), congenital hip dislocation (28 cases; 20.6 %), paralytic hip dislocation (36 cases; 26.5 %), proximal femoral focal deficiency (14 cases; 10.3 %), neglected fracture of the femoral neck (10 cases; 7.4 %), osteoarthritis (6 cases; 4.4 %), and tuberculous hip arthritis (2 cases; 1.5 %). The intervention consisted in the performance of two osteotomies (proximal and distal) of the femur with pelviс support and placement of the Ilizarov apparatus of a specific assembly. Results The external fixation period ranged from 4 to 12 months (6.5 months on average). Patients were followed up for an average of 17.4 years (range, 5 to 27 years). Multiple clinical parameters at final follow-ups showed significant improvement, including pain relief, pain-free walking distance, lameness, hip flexion and abduction, hip contracture, and lumbar lordosis. Functionally, the mean Harris Hip Score improved with a statistically significant difference from 48 points (range, 35–65) before surgery to 83 points (range 70–90) after surgery. The pain disappeared in all patients, with the exception of six cases of pain in the early postoperative period. In all cases, supportive walking aids were no longer necessary, with the exception of two cases of persistent pain by physical activities. Walking ability and painless walking distance improved in all patients from an average of 35 m (range, 10 to 50 m) before surgery to 1,150 m (range, 1,000 to 1,500 m) after surgery, showing significant difference. Conclusion Ilizarov pelvic support osteotomy provided a multi-purpose solution to the complex challenging problem of hip instability in adolescents and young adults with variable primary etiologies. The improvements in the hip motion, mechanical axis, and correction of limb-length discrepancy lead to good functional outcomes over a long-term follow-up. This treatment modality might avoid or postpone the need for total hip arthroplasty for several years.

SCHANZ OSTEOTOMY A FADING ART

The pelvic support osteotomy is a useful surgical procedure for the salvage of damaged hips of patients in whom arthrodesis or hip arthroplasty are not appropriate either surgically or nancially. It is a procedure that has much to offer the adolescent or young adult who has painful limping, restriction of hip motion and early onset fatigue to walking as a consequence of hip destruction from AVN, TB hip, old neglected dislocation of hip, neglected acetabulum fracture or persistent severe hip dysplasia. A successful pelvic support osteotomy reduces limp by reducing the Trendelenburg lurch and compensating the limb length inequality. It provides stability by taking support on the hemipelvis and facilitates a more energy-efcient gait. In this article, the authors present their own experience with palliative Schanz osteotomy.

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques.

Introduction:Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening.Material and Methods:We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed.Results:The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures.Conclusion:Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.

DOUBLE FEMORAL OSTEOTOMY FOR THE TREATMENT OF SEVERE SEQUELAE OF THE IMMATURE HIP.

ABSTRACTObjective: To evaluate the results of double femoral osteotomy for the treatment of severe sequelae of the hip. Methods: Immature patients with anatomical loss of the hip were treated with pelvic support osteotomy in the distal femur to correct lower limb shortening, they were evaluated clinically and radiographically. Results: Eleven cases (eleven hips) were assessed with verage follow-up of three years. The mean age of the patients was 14.7 years. Seven patients had sequela of infectious arthritis; three had sequela of developmental dysplasia of the hip and one patient had a sequela of slipped capital femoral epiphysis. Preoperatively, the gluteus medius was insufficient in all patients, and it became negative in ten of them. The average of lower limb shortening was 5 cm (2.5 to 7 cm) and reduced shortening was 1.9 cm (0 to 4 cm). According to Paley Classification, 72.7% of complications were considered problems, 90.9% were considered obstacles and 27.2% complications, among which the limitation of the knee flexion was the most frequent. Conclusion: The technique yielded good results, considering the severity of the sequela and the absence of a better therapeutic option. No important sequela was associated with the treatment. Level of Evidence IV, Case series.

Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction.

Aim and objectiveIlizarov hip reconstruction (IHR) is a traditional method of salvaging chronic adolescent problem hips but faces practical issues from external fixators leading to reduced compliance. We present the same reconstruction procedure using only internal devices with a modification in the technique and review early results.Materials and methodsWe retrospectively evaluated eight patients between 2014 and 2017 with chronic painful hips treated by two-stage reconstruction; stage I included femoral head resection and pelvic support osteotomy using double plating, whereas stage II comprised distal femoral osteotomy avoiding varus followed by the insertion of a retrograde magnetic nail for postoperative lengthening. Patients continued physiotherapy postoperatively while protecting from early weight-bearing.ResultsAt a mean follow-up of 19 months (range, 6–36), all osteotomies healed with a bone healing index of 47 days/cm (range, 30–72). Pain improved from 8.3 (range, 7–9) to 2 (range, 0–6) while the limb length discrepancy got corrected from 4.3 cm (range, 3–5) to 1.4 cm (range, 0–2.5) at the final follow-up. Trendelenburg sign was eliminated in three patients and delayed in five patients. No examples of infection or permanent knee stiffness were noted. One patient had plate breakage due to mechanical fall, and another patient had 35 mm of lateral mechanical axis deviation (MAD) requiring corrective osteotomy.ConclusionPelvic support hip reconstruction with exclusive internal devices is a technique in evolution with encouraging early results. It avoids common complications of external fixators and facilitates quick rehabilitation of joints. Refraining from distal varus can effectively eliminate Trendelenburg gait, although with some degree of lateral MAD. Unlike external fixation where there is a possibility of gradual correction, this staged procedure of internal fixation is technically demanding with a learning curve.Clinical significancePelvic support hip reconstruction performed by internal implants is a viable alternative to Ilizarov hip reconstruction with potential benefits.How to cite this articleMetikala S, Kurian BT, Madan SS, et al. Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction. Strategies Trauma Limb Reconstr 2020;15(1):34–40.

Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction.

Aim and objectiveIlizarov hip reconstruction (IHR) is a traditional method of salvaging chronic adolescent problem hips but faces practical problems from external fixators leading to reduced compliance. We present the same reconstruction utilising only internal devices with a modification in technique and aim to review early results.Materials and methodsWe retrospectively evaluated eight patients between 2014 and 2017 with chronic painful hips treated by a two-stage reconstruction; stage 1 included femoral head resection and pelvic support osteotomy using double plating, while stage 2 comprised distal femoral osteotomy avoiding varus followed by insertion of retrograde magnetic nail for postoperative lengthening. Patients continued physiotherapy postoperatively while protecting from early weight-bearing.ResultsAt mean follow-up of 19 months (range 6–36), all osteotomies healed with bone healing index of 47 days/cm (range 30–72). Pain improved from 8.3 (range 7–9) to 2 (range 0–6), while limb length discrepancy got corrected from 4.3 cm (range 3–5) to 1.4 cm (range 0–2.5) at final follow-up. Trendelenburg sign was eliminated in three and delayed in five. No examples of infection or permanent knee stiffness were noted. One patient had plates breakage due to mechanical fall and one had 35 mm of lateral mechanical axis deviation requiring corrective osteotomy.ConclusionPelvic support hip reconstruction with exclusive internal devices is a technique in evolution with encouraging early results. It avoids common complications of external fixators and facilitates quick rehabilitation of joints. Refraining from distal varus can effectively eliminate Trendelenburg gait, albeit with some degree of lateral mechanical axis deviation. Unlike external fixation where there is a possibility of gradual correction, this staged procedure of internal fixation is technically demanding with a learning curve.Clinical significancePelvic support hip reconstruction performed by internal implants is a viable alternative to IHR with potential benefits.How to cite this articleMetikala S, Kurian BT, Madan SS, et al. Pelvic Support Hip Reconstruction with Internal Devices: An Alternative to Ilizarov Hip Reconstruction. Strategies Trauma Limb Reconstr 2020;15(2):91–97.

PELVIC SUPPORT OSTEOTOMY WITH ILIZAROV METHOD;

Objectives: To determine the outcome of pelvic support osteotomy with Ilizarovmethod in patients undergoing Girdle stone procedure in terms of pain relief and limb lengthdiscrepancy. Study Design: Descriptive case series. Setting: Department of Orthopaedicand Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical &amp; Dental College, Lahore.Duration of Study: Six months (19-11-09 to 18-05-10) for sample collection and follow upfor next one year after the procedure. Materials and Methods: Forty five patients having hipjoint problems were included. The radiographs would include plain radiographs of the pelvisin neutral and single limb standing position and the femur of involved side to assess the pelvicobliquity. Surgery was performed in the supine position under spinal anesthesia. A proximalfemoral osteotomy was performed at the level of ischial tuberosity. The other distal femoralosteotomy was performed to lengthen and adjust the mechanical axis. Both these osteotomieswere then stabilized with Ilizarov external fixator. The standard rate of distraction is 1 mm/dayfor lengthening. Results: There were 30 male patients and 15 were female patients with maleto female ratio was 2:1. The mean ± SD between the ages was 23.69±7.80 years. Among allpatients, 43 patients had pain relief and 41 patients of limb length discrepancy. Conclusion:By using the Ilizarov technique, we could prevent the valgus effects created by the valgusextension osteotomy while achieving lengthening of the femur through the distal osteotomy inthe femur. It is an excellent technique for those patients who are not fit for total hip replacement.

English

Objectives: To determine the outcome of pelvic support osteotomy with Ilizarovmethod in patients undergoing Girdle stone procedure in terms of pain relief and limb lengthdiscrepancy. Study Design: Descriptive case series. Setting: Department of Orthopaedicand Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical &amp; Dental College, Lahore.Duration of Study: Six months (19-11-09 to 18-05-10) for sample collection and follow upfor next one year after the procedure. Materials and Methods: Forty five patients having hipjoint problems were included. The radiographs would include plain radiographs of the pelvisin neutral and single limb standing position and the femur of involved side to assess the pelvicobliquity. Surgery was performed in the supine position under spinal anesthesia. A proximalfemoral osteotomy was performed at the level of ischial tuberosity. The other distal femoralosteotomy was performed to lengthen and adjust the mechanical axis. Both these osteotomieswere then stabilized with Ilizarov external fixator. The standard rate of distraction is 1 mm/dayfor lengthening. Results: There were 30 male patients and 15 were female patients with maleto female ratio was 2:1. The mean ± SD between the ages was 23.69±7.80 years. Among allpatients, 43 patients had pain relief and 41 patients of limb length discrepancy. Conclusion:By using the Ilizarov technique, we could prevent the valgus effects created by the valgusextension osteotomy while achieving lengthening of the femur through the distal osteotomy inthe femur. It is an excellent technique for those patients who are not fit for total hip replacement.

Pelvic Support Osteotomy; Salvage Procedure in Chronically Dislocated Hips Case Report: Technical Note on the On-lay Bone Positioning of a Lengthening Nail and Review of the Literature.

Background:Young patients with a acquired dislocation of the hip with concomitant shortening of the lower limb is a difficult diagnostic problem with few definite treatment options.Methods:We used the technique, originally described by Ilizarov, with a double femur osteotomy and lengthening the femur. Lengthening was done with a sub muscular placed on-lay femur distraction rod. Distraction of the rod was done by fluid mechanics. After lengthening, the distraction was secured by a parked plate by locking the distal part of the plate.Results:This patient needed a lengthening of 60 mm, distraction time was 36 days with a distraction index of 1.61 mm per day and a healing index of 31.4 days per cm lengthening.We encountered one complication in which an exchange of the plastic feeding tube was needed at 20 days post-surgery. Conclusions:In the reported case we could improve gait with reduced limping and equalizing her leg length discrepancy.

Ilizarov hip reconstruction osteotomy for neglected dislocation of the hip in young adults

Background Neglected dislocation of the hip joint in young adults is a difficult problem. Patients with an unstable hip secondary to any aetiology usually have loss of bone from the proximal femur or shortening of the limb or both. Objective In the present study we report our results in the treatment of the neglected dislocation of the hip joint in young adults by pelvic support osteotomy using the Ilizarov method. Patients and methods From 2007 to 2014, 30 patients (20 women and 10 men) with neglected dislocation of the hip joint were treated in the Orthopaedic Department of Al-Azhar University Hospital, Damietta, Egypt. Their mean age was 22.5 years (range: 19–35 years). The main complaints were pain, leg length discrepancy, limping and limited abduction of the hip. All patients underwent valgus extension osteotomy in the proximal femur and distal femoral osteotomy for lengthening. The average follow-up ranged from 2 to 7 years. Results All hips were pain free at follow-up. The Trendelenburg sign became negative in 25 patients. There was no limb length discrepancy and alignments of the extremity were re-established. Five patients had a lurch gait. Valgus extension osteotomy provided stability of the hip joint and maintained some motion of the hip joint. By using the Ilizarov technique we could prevent the valgus effects created by the valgus extension osteotomy while achieving lengthening of the femur through distal osteotomy in the femur. Conclusion Pelvic support osteotomy with Ilizarov modification can provide an alternative to other techniques in managing patients having excision arthroplasty who are severely disabled as a result of abductor weakness, instability and limb length discrepancy.

Reconstruction of Unstable Hips with Ilizarov Technique. Role of Pelvic Support and Distal Lengthening Realignment Osteotomy.

Hips can suffer severe damage due to untreated developmental dysplasia, septic arthritis, tuberculosis, a neglected fracture of the neck of femur and neglected hip dislocation. The Ilizarov technique offers an effective treatment by providing a stable hip with abolished Trendelenburg lurch and equalizing limb length discrepancy through distal lengthening realignment osteotomy. 20 patients with hip instabilities due to various etiologies were treated with the Ilizarov technique of pelvic support osteotomy and distal lengthening realignment osteotomy. There were 12 females and 8 males in the study group and the age range was 13 to 30 years. Average limb length discrepancy was 5.95 cms (range 4-8.5 cms).The pre-operative and post-operative range of motion and Harris hip score was collected and data analyzed by Student's paired t test. A p value of < 0.05 was taken to be statistically significant Results. The functional Harris hip score improved in all the patients at final follow-up. The mean Harris hip score was 56.95 (range 33-71) pre-operatively, which improved to 83.25 (range 73-85) at final follow up and was statistically significant (P-value < 0.05). The mean length achieved was 5.53 cms (4-8 cms). The mean external fixation time was 8.6 months and the mean healing index was 1.54 months /cm. 1. Ilizarov hip reconstruction is an excellent method of salvage in patients with unstable hips diverse etiologies especially in this part of the world, where patients demand unrestricted range of motion at hip, and in the younger age group, where other procedures do not offer a long term solution. 2. It provides an excellent functional outcome in hips of different etiologies. 3. However, for an excellent outcome, surgical expertise, patient compliance and meticulous follow-up are mandatory.

A case of late sequela of infantile hip infection treated by Ilizarov hip reconstruction using monolateral fixator

A 13-year-old female presented with chronic instability of her left hip due to late sequela of infantile hip infection. Instability of hip causes significant problems due to pain, limp, and shortening. Such a case is rare and difficult to treat. We performed a subtrochanteric valgus extension pelvic support osteotomy, along with distal varization and lengthening osteotomy utilizing a monolateral fixator. The patient was clinically and radiologically followed up for 24 months after her operation. The fixator was removed after 12 months once radiological union and adequate lengthening was achieved. Pre- and postoperative assessments were done using the Harris Hip Score, which showed a significant improvement. Long duration of usage of the fixator, knee stiffness, and pin tract infections are a few of the limitations observed.

Lower limb kinematics following pelvic support osteotomy for unilateral avascular necrosis of the femoral head

Introduction: Avascular necrosis of the femoral head (AVN) has devastating long term consequences for hip joint mobility and lower limb function. Management is complex, there is no accepted gold standard treatment and there has been only limited evaluation of the gait characteristics of this group [1–3]. To evaluate the management of this condition functionally, a twostage study has been undertaken. Stage one, a retrospective cohort study of the gait of young people with femoral head AVN (presented previously) and stage two, evaluation of these patients post pelvic support osteotomy PSO (current paper). Patients/materials and methods: A standard threedimensional gait analysis was performed post operatively on 17 patients following PSO for femoral head AVN using a 6camera Vicon® 370 system, Kistler® force platform and Plug in Gait® software. From a representative cycle for each patient, mean ± 1 standard deviation were calculated for waveform throughout the cycle for affected and unaffected sides. These were compared to the laboratory normal adult dataset (Figure 1.). Paired t-tests were performed where data were normally distributed. Results: The cohort comprised 11 males and 6 females, mean age 17 years (range 15-19). Initial analysis of the data revealed increased hip excursion and shift towards normal range with associated improvements in pelvic excursion and alignment. Therewas a shift towards normal timing and magnitude of knee flexion in stance. Length discrepancy persisted in all cases although compensatory equinus was reduced. Discussion & Conclusions: Analysis of three dimensional gait analysis post pelvic support osteotomy for unilateral avascular necrosis of the femoral head, revealed significant improvements in lower limb kinematics. Although residual leg length discrepancy was evident in themajority of the cohort, PSOappears to represents a functionally beneficial surgical option for this group of patients. Further comparative evaluation is required to establish the optimal surgical intervention for this group of patients.

Pelvic Support Osteotomy and Limb Reconstruction for Septic Destruction of the Hip

Joint instability and limb shortening due to septic destruction of the hip may not be correctable by reduction, fusion, or total joint arthroplasty. In these circumstances, a unique Ilizarov pelvic support osteotomy combined with reconstructive angular correction and lengthening of the limb can ameliorate Trendelenburg gait, restore knee alignment, and correct leg length discrepancy. Surgical reconstruction includes double-level femoral osteotomy resulting in 3 fragments (proximal, middle, and distal). Typically, the proximal osteotomy is a complex valgus-extension-derotation proximal femoral intertrochanteric or subtrochanteric osteotomy with adduction of the proximal fragment and proximal-medial translation of the distal segment to form a new weight-bearing surface between the pelvis and proximal femur (pelvic support). Distal osteotomy at the level of femoral diaphysis or distal metaphysis is used for gradual lengthening and angular correction of the position of the distal fragment to restore limb length and mechanical axis as well as correct associated angular deformity of the knee joint. This article describes the rationale and basic principles of Ilizarov pelvic support osteotomy and limb reconstruction using circular external fixation for septic destruction of the hip with an illustrative case example.

Recurrent Dislocations and Complete Necrosis

The basic concepts and goals of pelvic support osteotomy (PSO) are to enhance femoro-pelvic stability by proximal femoral valgus osteotomy and to improve hip biomechanics by displacing the center of gravity medially, which results in an improvement in the mechanical efficiencies of abductor muscles. However, the clinical application of traditional PSO is limited due to its intrinsic shortcomings. Ilizarov designed a modified PSO, so called "Ilizarov hip reconstruction (IHR)," which incorporated a second distal femoral osteotomy, to realign the knee joint and to correct limb-length discrepancy and proximal femoral valgus osteotomy for pelvic support. IHR remains as a viable option for the salvage of severely damaged hips in the adolescents and young adults in whom arthrodesis or hip arthroplasty is not suitable. The purpose of this article is to briefly review the evolution of PSO and to concentrate on the technical considerations and outcomes of IHR.

Total hip replacement fifteen years after pelvic support osteotomy (PSO): a case report and review of the literature

Treatment of chronic hip instability in children and young adults is challenging. Proximal femoral osteotomy had been suggested to provide pelvic stability and improved abductor function. Total hip replacement after pelvic support osteotomy can be challenging due to altered anatomy due to angulation of the proximal femur in both frontal and sagittal planes. This is a 29-year-old woman who had total hip replacement after pelvic support osteotomy. The patient had pelvic support at the age of 14 years. Pelvic support osteotomy delayed the need for total hip replacement for 15 years. Preoperative planning for total hip replacement with model was used for proper understanding of the anatomy of the proximal femur. Revision of femoral component was necessary due to penetration of the proximal femur. In conclusion, total hip replacement after pelvic support osteotomy is a technically demanding procedure, and careful attention to surgical details is necessary for successful outcome.

Pelvic support osteotomy for unstable hips using hybrid external fixator: case series and review of literature

BackgroundInstability of the hip joint is a source of great discomfort to the patient due to pain, limp and leg-length discrepancy. Pelvic support osteotomy with Ilizarov hip reconstruction, along with its various modifications, has emerged as a standard treatment modality for this difficult problem. We present a series of patients with unstable hips treated with a modification of the monolateral fixator-the hybrid external fixator. Materials and methodsA retrospective review of a series of 23 patients (38 hips) with unstable hips treated at our institute with the hybrid external fixator was performed. The mean age of the patients was 19.1years (range 7–49years). The outcomes were evaluated radiologically and clinically using the Harris hip score. ResultsAfter a mean follow-up period of 30.5months (range 10–91months), the range of motion of the hip had improved, pain had decreased, and the Harris hip score had improved from 63.43 to 75.17, which was statistically significant. The pre-operative knee range of motion was achieved in all patients by the last follow-up. Trendelenburg gait disappeared in all patients except for 3, limb length discrepancy improved from a pre-operative mean of 43mm to a post-operative mean of 5mm at final follow-up, and the mechanical axis was regained in all patients. Pin-tract infections were the commonest complications, occurring in 12 patients (52%). ConclusionsThis study shows that pelvic support osteotomy using the new hybrid external fixator, which combines the versatility and modularity of the Ilizarov frame with the compactness of the monolateral fixator, is a useful treatment modality in individuals with unstable hips.

Ilizarov hip reconstruction in skeletally mature young patients with chronic unstable hip joints

Hip reconstruction with subtrochanteric valgus extension pelvic support osteotomy and distal femoral osteotomy for lengthening and varus correction is one of the options available for salvage of chronic unstable hips and is also known as Ilizarov hip reconstruction (IHR). This study evaluated the outcomes and complications associated with IHR in skeletally mature young patients. Twelve patients (7 males, 5 females) with a mean age of 23 years underwent IHR for chronically dislocated hips due to various causes. Preoperative clinical and radiological evaluations were used to determine the site of osteotomies and the required angulations. Postoperatively the patients were followed up clinically and radiologically for a minimum of 36 months. Ilizarov fixator was removed when adequate lengthening was achieved and there was radiological evidence of union. Harris Hip Score was used to document hip function preoperatively and at final evaluation. Significant improvements occurred in limb length discrepancy (LLD) 5.11 cm preoperatively to 0.9 cm at final evaluation, Harris Hip Score 44.33 points preoperatively to 70.83 points (p < 0.0001) at final evaluation. Trendelenberg sign disappeared completely in nine patients and was delayed in three at final evaluation. The abduction at the hip increased from the preoperative mean of 12.08° (range 0°-25°) to 22.5° (range 15°-35°) postoperatively. The fixed flexion deformity at the hip decreased from 22° (range 10°-35°) preoperatively to 3° postoperatively (range 0°-10°). The amount of free flexion at the operated hips decreased from the preoperative mean of 88.33° (range 70°-120°) to 70.42° (range 45°-105°) at final follow up. The mean fixator interval was 7.33 months (5-12 months) and the mean follow up duration was 59.4 months (38-86 months). IHR is effective in improving the hip biomechanics, correcting the LLD and eliminating the Trendelenberg sign. Lengthy period of fixator wear, knee stiffness and pin tract infections, though minor are known limitations of this procedure.