A Modified Periacetabular Osteotomy with Use of the Transtrochanteric Exposure

• Published in: Journal of bone and joint surgery. American volume 2003-02, Vol.85 (2), p.244-250
• Main Authors: Hsieh, Pang-Hsin, Shih, Chun-Hsiung, Lee, Po-Cheng, Yang, Wen-E, Lee, Zhon Liau
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Female; Hip Dislocation, Congenital - complications; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Osteoarthritis, Hip - etiology; Osteoarthritis, Hip - surgery; Osteotomy - methods; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200302000-00010

BackgroundPeriacetabular osteotomies are technically demanding surgical procedures. We developed a modified technique that uses a transtrochanteric approach. Our goal was to facilitate surgical exposure without compromising the results of surgery. The purpose of the present study was to review the early results in our initial group of patients who had this procedure.MethodsWe retrospectively reviewed the results of a modified periacetabular osteotomy in thirty-eight consecutive patients (forty-six hips) at an average duration of follow-up of 4.2 years. The average age of the patients was thirty-one years (range, eighteen to fifty-eight years) at the time of surgery. We evaluated the results with use of serial radiographs and the Merle dʼAubigné and Postel hip-scoring system.ResultsAll osteotomies healed. Preoperatively, the average lateral center-edge angle was 3° (range, -15° to 12°), the anterior center-edge angle was 0° (range, -20° to 5°), the acetabular angle of Sharp was 57° (range, 50° to 68°), and the femoral head coverage was 53% (range, 40% to 66%). Postoperatively, the average lateral center-edge angle was 35° (range, 23° to 45°), the anterior center-edge angle was 32° (range, 20° to 55°), the acetabular angle of Sharp was 40° (range, 37° to 45°), and the femoral head coverage was 92% (range, 85% to 100%). The average amount of medialization of the femoral head was 6 mm. At the latest follow-up examination, improvement in the grade of osteoarthritis was noted in eight hips, while progression of osteoarthritis was seen in five hips. Functionally, the average Merle dʼAubigné and Postel hip score improved from 13.2 points preoperatively to 17.0 points postoperatively. No patient had a neurovascular complication.ConclusionOur early experience with a modified periacetabular osteotomy showed encouraging results in terms of the technical ease of the technique and the outcome in our patients.Level of EvidenceTherapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.