Periacetabular Pelvic Osteotomy in Treatment of Patients with Developmental Dysplasia of the Hip

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Abstract

Background. Pelvic osteotomies are widely used for treatment of young active patients with developmental dysplasia of the hip (DDH) Type I according to the Crowe or type A according to Hartofilakidis classifications and the absence of severe degenerative cartilage lesions. Nowadays, Ganz periacetabular osteotomy (PAO) is the most common choice of surgeons around the world in treatment of such patients.

The aim of the study was to evaluate the radiological and functional results of Ganz periacetabular osteotomy in patients with DDH.

Material and Methods. A single-center retrospective analysis of 49 Ganz PAO was performed in 43 patients aged 36±9 years. The radiological evaluation criteria were Wiberg (AW), Lequesne (AL), Tonnis (AT) angles, and joint medialization. The results of treatment were evaluated using the Harris scale, iHOT-12, and VAS before treatment and 1 year after, the presence of complications was also monitored.

Results. The average follow-up period was 35±15 months (from 1.0 to 6.9 years). Radiological parameters improved after surgery compared to preoperative ones: AW +19.9° (17.1° vs. 37.0°), AT -11.5° (19.9° vs. 8.4°), AL +14.1° (25.1° vs. 39.2°), joint medialization -5.5 mm (14.3 mm vs. 8.8 mm) (p<0.001). Functional results and quality of life of patients also improved: the Harris scale +35.6 points (47 vs 83 points), iHOT-12 +40.9 points (44 vs 85 points), pain level -2.8 points (5 vs 2 points) (p<0.001). Various complications developed in 20 out of 49 cases (40.8%). Neurological complications were resolved conservatively (22.4%). A direct correlation was evaluated between the surgical treatment of DDH in childhood and the development of neurological complications after PAO (R = 0.76; p<0.001). In 9 cases out of 49 (18.4%), revision surgery was required: in 3 — total hip replacement, in 2 — reorientation of the acetabulum, in 4 — arthroscopic fixation of the anterior articular lip. In 93.9% of cases native hip joint surfaces were preserved.

Conclusion. Ganz PAO has good reconstructive capabilities and sufficient efficiency. The operation allows to restore the coverage of the femoral head with the acetabulum, delays total hip replacement and provides improved functional results.

About the authors

A. A. Korytkin

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: andrey.korytkin@gmail.com
ORCID iD: 0000-0001-9231-5891

Andrey A. Korytkin — Cand. Sci. (Med.), Director

Novosibirsk

Russian Federation

Ya. S. Novikova

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Author for correspondence.
Email: novikova_jana@mail.ru
ORCID iD: 0000-0003-3301-1825

Yana S. Novikova — Cand. Sci. (Biol.), Researcher

Novosibirsk

Russian Federation

Yo. M. El moudni

Ibn Rochd University Hospital

Email: elmoudni.younes@outlook.com
ORCID iD: 0000-0001-9070-5626

Younes M. El moudni — Orthopedic Surgeon

Casablanca

Morocco

K. A. Kovaldov

Privolzhsky Research Medical University

Email: kovaldovc@gmail.com
ORCID iD: 0000-0001-9314-2881

Kirill A. Kovaldov — Orthopedic Surgeon, University Clinic

Nizhny Novgorod

Russian Federation

S. A. Gerasimov

Privolzhsky Research Medical University

Email: gerasimoff@list.ru
ORCID iD: 0000-0002-3179-9770

Sergey A. Gerasimov — Cand. Sci. (Med.), Head of Adult Orthopedics Department, University Clinic

Nizhny Novgorod

Russian Federation

E. V. Gubina

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: egubina@niito.ru
ORCID iD: 0000-0002-2278-1421

Elena V. Gubina — Cand. Sci. (Med.), Head Doctor

Novosibirsk

Russian Federation

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