Blog
About

1
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH.

          Methods

          We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria.

          Results

          Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458).

          Conclusion

          The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient’s specific acetabular deficiency

          Level of evidence

          Level III retrospective comparison

          Related collections

          Most cited references 25

          • Record: found
          • Abstract: found
          • Article: not found

          Avascular necrosis following treatment of congenital dislocation of the hip.

           A Kalamchi,  G MacEwen (1980)
          A review of 119 patients with congenital dislocation of the hip complicated by avascular necrosis, of whom fifty-one patients were skeletally mature, showed that damage to the physis was very common. Changes in the secondary ossification center (ossific nucleus) alone were found to be of very little value in predicting the nature of the development of the hip, while the change in the proximal femoral physis was the key to predicting residual deformity. The vascular disturbances were classified into four groups depending on the amount of damage involving the ossific nucleus and the physis during treatment of the dislocation. This classification was found to be accurate in predicting the natural history of avascular necrosis. The more severe forms of avascular necrosis were found to be most prevalent in those patients in whom treatment was begun between birth and the age of six months. We also found that preliminary traction and the use of general anesthesia reduced the incidence of the more severe form of avascular necrosis. The functional results found in the skeletally mature patients coincided with the types of vascular changes; the presence of avascular necrosis enhanced the development of arthritis, especially if residual dysplasia and subluxation also were present.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage.

            We performed a combined one-stage approach for the treatment of eighteen spastic subluxated or dislocated hips in eleven children who had cerebral palsy. All patients were between five and thirteen years old and had spastic subluxation or dislocation of the hip and severe acetabular dysplasia. The operation consisted of release of the adductors, psoas, and proximal hamstrings; a femoral-shortening varusderotation osteotomy; and a pericapsular pelvic osteotomy. The pelvic osteotomy was designed to increase superolateral coverage of the femoral head in the elongated acetabulum, which had erosion of the superior and lateral aspects. At the latest follow-up (mean duration, six years and ten months), seventeen of the eighteen hips remained anatomically reduced.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips.

              Ninety-two patients with cerebral palsy underwent a special type of pericapsular acetabuloplasty designed to correct the hip dysplasia that occurs in cerebral palsy. The osteotomy was performed as part of a combined procedure (including femoral osteotomy and soft-tissue releases). Retrospective analysis was performed on 75 of the children (104 hips from 1982 through 1995) with a mean follow-up of 6.9 years. Ninety-nine (95%) of the 104 hips remained well reduced at follow-up. There were no redislocations. If the preoperative migration percentage was >70% (severe subluxation), improved results were noted in hips that had an open reduction with capsulorrhaphy. There were 13 complications including intraarticular extension of the acetabuloplasty (one) and avascular necrosis of the femoral head (eight hips, 8%). Indications for addition of a pericapsular acetabuloplasty include an open triradiate cartilage, acetabular dysplasia (acetabular index >25 degrees), and subluxation or dislocation with a migration percentage of >40%. Even hips with relative incongruity and some deformity of the femoral head can be successfully treated with this combined approach.
                Bookmark

                Author and article information

                Journal
                J Child Orthop
                J Child Orthop
                jco
                Journal of Children's Orthopaedics
                The British Editorial Society of Bone & Joint Surgery (London )
                1863-2521
                1863-2548
                1 April 2019
                : 13
                : 2
                : 172-179
                Affiliations
                [1 ]org-divisionUniversity of California, San Diego Medical Center , San Diego, California, USA
                [2 ]org-divisionRady Children’s Hospital , San Diego, California, USA
                Author notes
                [a ] Correspondence should be sent to Vidyadhar V. Upasani, MD, Rady Children’s Hospital, San Diego, 3020 Children’s Way, Mail Code 5062, San Diego, CA 92123, USA. E-mail: vupasani@ 123456rchsd.org
                Article
                jco-13-172
                10.1302/1863-2548.13.190004
                6442505
                Copyright © 2019, The author(s)

                Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

                Categories
                Original Clinical Article
                childrens-orthopaedics, Children’s Orthopaedics

                Orthopedics

                hip dysplasia, pemberton osteotomy, san diego acetabuloplasty

                Comments

                Comment on this article