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      Modified triple pelvic osteotomy for residual acetabular dysplasia through double incisions: Technical note and review of short-term results

      research-article
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      SICOT-J
      EDP Sciences
      Acetabular dysplasia, DDH, Pelvic osteotomy, Triple pelvic osteotomy, PAO

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          Abstract

          Purpose: To assess validity, safety, and efficacy of the modified triple pelvic osteotomy (TPO) approach for correction of residual acetabular dysplasia. Methods: This is a retrospective case series conducted on 15 hips in 15 patients from 2019 to 2023 with residual acetabular dysplasia treated by modified TPO as described by Tonnis with two modifications. The first modification is using a single medial incision for pubic and ischial cuts (the Vladimirov modification). The second modification is having the ischial cut closer to the acetabulum (Li modification) allowing free movement of the acetabular fragment for better femoral head coverage. The mean age at the time of surgery was 11.85 years, (range 8–23). Cases presenting were 10 males (66.7%) and 5 females (33.3%). The mean follow-up period was 36.533 months (24–60 months). Results: Our study revealed significant clinical and radiological improvement. The CE angle improved from a mean value of 10° (range 2–17) pre-operatively to 32.785° (range 18°–40°) post-operatively. The AI improved from a mean value of 32° pre-operatively to a mean value of 13.89° post-operatively. HHS increased from a preoperative mean value of 74.80° to a post-operative mean value of 90.67°. Also, there was a significant improvement in ROM (abduction and internal rotation). LLD improved from a mean value of 2.60 cm preoperatively to a mean value of 0.37 cm postoperatively. Delayed union was found in 3 cases. No cases of osteonecrosis or neurovascular complication were encountered in our study. Conclusion: The modified TPO technique using dual incisions can be considered safe and effective, providing adequate coverage of the femoral head in acetabular dysplasia with less surgical time, satisfactory functional outcomes, and minimal complications.

          Level of Evidence: IV

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          Most cited references28

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          Hip Dysplasia in the Young Adult.

          Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip. An increase in mechanical stress on the cartilage matrix with failure of the acetabular labrum represents the major pathomechanism of degeneration. Because the prevalence of associated femoral deformities is high (>50%), the structural anatomy of the dysplastic hip must be assessed in multiple planes using radiographs and, if needed, advanced imaging modalities. Acetabular osteotomy (periacetabular and/or rotational) is the most commonly used procedure for the treatment of the majority of dysplastic hips in adults. Modern total hip replacement remains an excellent option for the more arthritic joints. Difficulties can arise from anatomical abnormalities and previous operations.
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            Periacetabular osteotomy through the Smith-Petersen approach.

            Sixty-six hips in 58 patients that had undergone periacetabular osteotomy for residual acetabular dysplasia were available for clinical and radiographic followup at a minimum of 2 years (average, 4 years) after surgery. The final clinical results were graded as 17% excellent, 59% good, 12% fair, and 12% poor. No patient who met the ideal indications for surgery had a poor result during the study period. After reviewing the results, the authors remain positive regarding the periacetabular osteotomy and recommend it for individuals with hip pain and radiographic evidence of acetabular dysplasia.
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              Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips.

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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2024
                30 April 2024
                : 10
                : 14
                Affiliations
                Department of Orthopedics surgery, Faculty of Medicine Ain Shams University Abbasia square Nasr City Cairo Egypt
                Author notes
                [* ]Corresponding author: karimelhusseiny3@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-6717-7615
                Article
                sicotj240005 10.1051/sicotj/2024012
                10.1051/sicotj/2024012
                11060049
                38687149
                9be72c8a-c3b9-4f1d-872f-c74d699cdf0d
                © The Authors, published by EDP Sciences, 2024

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 January 2024
                : 12 April 2024
                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 25, Pages: 9
                Categories
                Original Article
                Hip

                acetabular dysplasia,ddh,pelvic osteotomy,triple pelvic osteotomy,pao

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