Frequency of Acetabulum Retroversion Formation after Reorienting Pelvic Osteotomies in Children Over 7 Years Old with Developmental Dysplasia of the Hip

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Abstract

Background. One of the reasons for the development of the “pincer” type of femoroacetabular impingement are various reorienting pelvic osteotomies, which are widely used in the treatment of children with developmental dysplasia of the hip (DDH).

The aim of the study was to evaluate the frequency of formation of retroversion of the acetabulum after reorienting pubic-iliac, iliac-sciatic and triple pelvic osteotomies in children over 7 years old with DDH I–II degree according to Crowe.

Material and Methods. The retrospective study is based on the results of radiometry of 60 patients (69 hip joints) at an average age of 11.6±2.9 years with DDH I–II degree according to Crowe who underwent surgical treatment in 2014-2016. The patients were divided into three groups of 20 patients each. Group I underwent an iliac osteotomy. Group II underwent an ilio-sciatic osteotomy. In group III patients, the acetabulum was reoriented by triple (pubo-ilio-sciatic) pelvic osteotomy. In addition to standard radiometry of the hip joints, the following indicators were evaluated: signs of acetabular retroversion (“cross-over”, “posterior wall”, “ischial spine”), as well as the index of acetabular retroversion (ARI).

Results. The assessment of the main radiometric parameters of the spatial position and the correction value of the acetabulum was carried out at least 36 months after the surgical treatment. There were no statistically significant differences in the radiometric parameters of the spatial orientation of the acetabulum in group I and II patients (p>0.05), except for the degree of bone coverage, which was significantly higher in group II patients (p<0.05) than in group II patients, which indicated the presence of hypercorrection. In patients of group III, the values of the above-mentioned indicators varied within the physiological values. Retroversion of the acetabulum was observed in more than half of the patients in group I and in almost all patients in group II. In group III patients, acetabular retroversion was observed in only 3 patients.

Conclusion. In the vast majority of cases, a double pelvic osteotomy (pubo-iliac and ilio-sciatic) leads to the formation of hypercorrection of the acetabular fragment and its retroversion in comparison with a triple pelvic osteotomy. The pathological orientation of the acetabulum, despite the achieved stability of the hip joint, can be a morphological substrate for the development of femoro-acetabular impingement and, as a result, coxarthrosis. In the treatment of children with DDH over 7 years old the operation of choice is a triple pelvic osteotomy.

About the authors

P. I. Bortulev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817

Pavel I. Bortulev — Cand. Sci. (Med.), Research Associate

St. Petersburg

Russian Federation

S. V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Mechnikov North-Western State Medical University

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048

Sergei V. Vissarionov — Corresponding member of RAS, Dr. Sci. (Med.), Professor, Director, Head of the department of Spinal Pathology and neurosurgery; Professor

St. Petersburg

V. E. Baskov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dr.baskov@mail.ru
ORCID iD: 0000-0003-0647-412X

Vladimir E. Baskov — Cand. Sci. (Med.), Head of the Department of Hip Pathology

St. Petersburg

D. B. Barsukov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634

Dmitry B. Barsukov — Cand. Sci. (Med.), Senior Researcher

St. Petersburg

I. Yu. Pozdnikin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586

Ivan Yu. Pozdnikin — Cand. Sci. (Med.), Researcher

St. Petersburg

T. V. Baskaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434

Tamila V. Baskaeva — Orthopedıc Surgeon

St. Petersburg

References

  1. Поздникин Ю.И., Камоско М.М., Краснов А.И. с соавт. Система лечения дисплазии тазобедренного сустава и врожденного вывиха бедра как основа профилактики диспластического коксартроза // Вестник травматологии и ортопедии им. Н.Н.Приорова. - 2007; №3. – С.63-71
  2. PozdnikinYu.I., Kamosko M.M., Krasnov A.I. et al. Sistema lecheniya displazii tazobedrennogo sustava i vrozhdennogo vyvikha bedra kak osnova profilaktiki displasticheskogo koksartroza. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2007;(3):63-71. (InRuss).
  3. Kotlarsky P., Haber R., Bialik V., Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? // World J Orthop 2015; 6:886-901.
  4. Сертакова А.В., Морозова О.Л., Рубашкин С.А., Тимаев М.Х., Норкин И.А. Перспективы молекулярной диагностики дисплазии тазобедренных суставов у детей // Вестник Российской академии медицинских наук.2017; - Т.72. - № 3. - С. 195-202.
  5. Sertakova A.V., Morozova O.L., Rubashkin S.A., TimaevM.Kh., Norkin I.A Challenges of molecular-based diagnosis developmental dysplasia of the hip in childhood. Vestnik Rossiiskoi akademii meditsinskikh nauk. 2017;72(3):195-202 (In Russ). doi: 10.15690/vramn806
  6. Поздникин И.Ю., Басков В.Е., Волошин С.Ю., Барсуков Д.Б., Краснов А.И., Познович М.С. с соавт. Ошибки диагностики и начала консервативного лечения детей с врожденным вывихом бедра // Ортопедия, травматология и восстановительная хирургия детского возраста. 2017; – Т.5. №2. – С.42 - 51
  7. PozdnikinI.Yu., Baskov V.E., Voloshin S.Yu., Barsukov D.B., Krasnov A.I., Poznovich M.S. Errors of diagnosis and the initiation of conservative treatment in children with congenital hip dislocation. Ortopediya, travmatologiya i vosstanovitel'naya khirurgiya detskogo vozrasta. 2017;5(3):42-51 (In Russ). doi: 10.17816/PTORS5242-51
  8. Камоско М.М., Григорьев И.В. Остеотомии таза в лечении диспластической патологии тазобедренного сустава // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2010; - №1. – С. 90 – 93
  9. Kamosko M.M., Grigor’ev I.V. Pelvic osteotomies at treatment of dysplastic hip pathology // Vestnik travmatologii i ortopedii im. N.N. Priorova.2010;1:90-93. (InRuss).
  10. Sutherland D.H., Moore M. Clinical and radiographic outcome of patients treated with double innominate osteotomy for congenital hip dysplasia // J PediatrOrthop 1991;11(2):143-8. doi: 10.1097/01241398-199103000-00001
  11. Камоско М.М.,Басков В.Е., Мельченко Е.В. Григорьев И.В. Новая технология транспозиции вертлужной впадины // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2008; - №4. – С. 48 – 50
  12. Kamosko M.M., BaskovV.E., Mel’chenko E.V.,Grigor’ev I.V. New technique for acetabulum transposition // Vestnik travmatologii i ortopedii im. N.N. Priorova.2080;4:48-50. (InRuss).
  13. Li Y, Xu H, Slongo T et al. Bernese-type triple pelvic osteotomy through a single incision in children over five years: a retrospective study of twenty eight cases. Int Orthop. 2018;42(12):2961-2968. doi: 10.1007/s00264-018-3946-3.
  14. Farsetti P, Caterini R, De Maio F et al. Tonnis triple pelvic osteotomy for the management of late residual acetabular dysplasia: mid-term to long-term follow-up study of 54 patients. J Pediatr Orthop B. 2018 Nov 26. doi: 10.1097/BPB.0000000000000575.
  15. Grigoryan G., Korcek L., Eidelman M., Paley D., Nelson S. Direct Lateral Approach for Triple Pelvic Osteotomy //J Am AcadOrthop Surg. 2020;28(2):e64-e70. doi: 10.5435/JAAOS-D-16-00918. PMID: 31157758.
  16. Mimura T., Mori K., Kawasaki T., Imai S., Matsusue Y. Triple pelvic osteotomy: Report of our mid-term results and review of literature //World J Orthop. 2014;5(1):14-22. doi: 10.5312/wjo.v5.i1.14.
  17. Giori N.J., Trousdale R.T. Acetabular retroversion is associated with osteoarthritis of the hip //Clin Orthop Relat Res. 2003;417:263–9doi: 10.1097/01.blo.0000093014.90435.64. PMID: 14646725.
  18. Bech N.H., Haverkamp D. Impingement around the hip: beyond cam and pincer //EFORT Open Rev. 2018;3(2):30-38. doi: 10.1302/2058-5241.3.160068.
  19. Goronzy J., Franken L., Hartmann A., Thielemann F., Blum S., Günther K.P., Nowotny J., Postler A. Acetabular- and femoral orientation after periacetabular osteotomy as a predictor for outcome and osteoarthritis //BMC Musculoskelet Disord. 2020;21(1):846. doi: 10.1186/s12891-020-03878-y.
  20. Hayashi S., Hashimoto S., Matsumoto T., Takayama K., Kamenaga T., Niikura T., Kuroda R. Preoperative anterior coverage of the medial acetabulum can predict postoperative anterior coverage and range of motion after periacetabular osteotomy: a cohort study //J Orthop Surg Res. 2020;15(1):312. doi: 10.1186/s13018-020-01818-z.
  21. Castaneda P., Vidal-Ruiz C., Me´ndez A., Salazar D.P., Torres A.HowOftenDoesFemoroacetabularImpingementOccurAfteranInnominateOsteotomyforAcetabularDysplasia? // Clin Orthop Relat Res. 2016;474:1209–1215 doi: 10.1007/s11999-016-4721-7
  22. Robb C.A., Datta A., Nayeemuddin M., Bache C.E. Assessment of acetabular retroversion following long term review of Salter's osteotomy //Hip Int. 2009;19(1):8-12. doi: 10.1177/112070000901900102
  23. Dora C., Mascard E., Mladenov K., Seringe R. Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip //J PediatrOrthop B. 2002;11(1):34-40. doi: 10.1097/00009957-200201000-00006
  24. Lerch T.D., Steppacher S.D., Liechti E.F., Tannast M., Siebenrock K.A. One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA //Clin Orthop Relat Res. 2017;475(4):1154-1168. doi: 10.1007/s11999-016-5169-5.
  25. Басков В.Е., Камоско М.М., Барсуков Д.Б., Поздникин И.Ю., Кожевников В.В., Григорьев И.В., Бортулёв П.И. Транспозиция вертлужной впадины после подвздошно-седалищной остеотомии таза при лечении дисплазии тазобедренного сустава у детей // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2016. – Т.4. – Вып.2. – с 5-11
  26. Baskov V.E., Kamosko M.M., Barsukov D.B., PozdnikinI.Yu., Kozhevnikov V.V., Grigor'ev I.V., Bortulev P.I. Transpozitsiya vertluzhnoi vpadiny posle podvzdoshno–sedalishchnoi osteotomii taza pri lechenii displazii tazobedrennogo sustava. Ortopediya, travmatologiya I vosstanovitel'naya khirurgiya detskogo vozrasta. 2016;(2)4:5-11(in Russ) doi: 10.17816/PTORS425-11
  27. M’sabah D.L., Assi C., Cottalorda J. Proximal femoral osteotomies in children // Orthopaedics& Traumatology: Surgery & Research. 2013. 99S:S171-186 doi: 10.1016/j.otsr.2012.11.003
  28. Бортулёв П.И., Виссарионов С.В., Басков В.Е., Барсуков Д.Б., Поздникин И.Ю., Познович М.С. Применение индивидуальных шаблонов при тройной остеотомии таза у детей с диспластическим подвывихом бедра (предварительные результаты) // Травматология и ортопедии России. 2019. – Т. 25. № 4 – с. 47-56.
  29. Bortulev P.I., Vissarionov S.V., Baskov V.E., Barsukov D.B., PozdnikinI.Yu., Poznovih M.S. [Patient specific templates for triple pelvic osteotomy in children with dysplastic hip subluxation (preliminary results)]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2019;25(3):47-56. (In Russ).doi: 10.21823/2311-2905-2019-25-3-47-56.
  30. ТихиловР.М., ШубняковИ.И., ПлиевД.Г. ссоавт. Возможности рентгенографии в ранней диагностике патологии тазобедренного сустава // Травматология и ортопедия России.- 2017; - Т.23. - №1. - С.117-131
  31. Tikhilov R.M., Shubnyakov I.I., Pliev D.G.et al. Roentgenography potentialities for early diagnosis of hip pathologies //Travmatologiya i ortopediya Rossii. 2017;23(1):117-131. (In Russ). doi: 10.21823/2311-2017-23-1-117-131
  32. Reynolds D., Lucas J., Klaue K. Retroversion of the acetabulum. A cause of hip pain // J Bone Joint Surg Br. 1999;81(2):281-8 doi: 10.1302/0301-620x.81b2.8291
  33. Wenger D.E., Kendell K.R., Miner M.R., Trousdale R.T. Acetabular labral tears rarely occur in the absence of bony abnormalities // Clin Orthop Relat Res. 2004;(426):145-150. doi: 10.1097/01.blo.0000136903.01368.20
  34. Kiyama T., Naito M., Shiramizu K., Shinoda T. Postoperative acetabular retroversion causes posterior osteoarthritis of the hip // Int Orthop. 2009;33(3):625-31. doi: 10.1007/s00264-007-0507-6.
  35. van Hellemondt G.G., Sonneveld H., Schreuder M.H., Kooijman M.A., de Kleuver M. Triple osteotomy of the pelvis for acetabular dysplasia: results at a mean follow-up of 15 years //J Bone Joint Surg Br. 2005;87(7):911-5. doi: 10.1302/0301-620X.87B7.15307.
  36. El-Hajj G., Abdel-Nour H., Ayoubi R., Maalouly J., Jabbour F., Ashou R., Nehme A. The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy //Adv Orthop.2020;2020:1826952. doi: 10.1155/2020/1826952.
  37. Konya M.N., Tuhanioğlu Ü., Aslan A. et al. A comparison of short-term clinical and radiological results of Tönnis and Steel pelvic osteotomies in patients with acetabular dysplasia. Eklem Hastalik Cerrahisi. 2013;24(2):96-101. doi: 10.5606/ehc.2013.22.
  38. Кожевников В.В., Ворончихин Е.В., Григоричева Л.Г., Лобанов М.Н., Буркова И.Н. Показания и эффективность лечения детей с остаточной дисплазией тазобедренного сустава путем тройной остеотомии таза // Детская хирургия. – 2017. – Т. 21. №4 – c. 197-201
  39. Kozhevnikov V. V., Voronchikhin E.V., Grigoricheva L.G., Lobanov M.N., Burkova I.N. Indications for and efficiency of treatment of children with residual hip joint dysplasia by triple pelvic osteotomy. Children surgery. 2017; 21(4):197-201.doi: 10.18821/1560-9510-2017-21-4-197-201
  40. Direito-Santos B, França G, Nunes J, Costa A, Rodrigues EB, Silva AP, Varanda P. Acetabular retroversion: Diagnosis and treatment //EFORT Open Rev. 2018;3(11):595-603. doi: 10.1302/2058-5241.3.180015.

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