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      Pelvic osteotomies in hip dysplasia: why, when and how?

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          Abstract

          • Acetabular dysplasia is a significant problem in the spectrum of developmental dysplasia of hip. In a younger child, positioning the femoral head into the acetabulum helps in reciprocal remodeling of the acetabulum and correction of dysplasia. In an older child, the remodeling potential is limited and often the acetabular dysplasia needs surgical intervention in the form of a pelvic osteotomy.

          • Thus, pelvic osteotomy forms an integral part of surgical management of hip dysplasia. The ultimate goal of these osteotomies is to preclude or postpone the development of osteoarthritis and add more years of life to the native hip.

          • Pelvic osteotomies play a pivotal role in normalizing hip morphology. The choice of pelvic osteotomy depends on the age of a child, the type of dysplasia and the status of the tri-radiate cartilage.

          • Several types of re-directional and reshaping pelvic osteotomies have been described in the literature to improve the stability and restore the anatomy and biomechanics of the dysplastic hip.

          • This article attempts to review the current indications for various pelvic osteotomies with a brief description of their techniques along with the outcomes and complications published thus far. Besides, the guidelines to choose the right pelvic osteotomy are also provided.

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          Most cited references52

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          A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.

          A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31 degrees for the vertical center-edge (VCE) angle of Wiberg and 26 degrees for the corresponding angle of Lequesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indomethacin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.
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            Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis

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              INNOMINATE OSTEOTOMY IN THE TREATMENT OF CONGENITAL DISLOCATION AND SUBLUXATION OF THE HIP

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                Author and article information

                Journal
                EFORT Open Rev
                EFORT Open Rev
                eor
                EFORT Open Reviews
                Bioscientifica Ltd (Bristol )
                2058-5241
                15 February 2022
                01 February 2022
                : 7
                : 2
                : 153-163
                Affiliations
                [1 ]Department of Orthopaedics & Spine Surgery, Ganga Hospital , Coimbatore, India
                [2 ]Alwaly Hospital , Aden, Yemen
                Author notes
                Correspondence should be addressed to N M M Al Ahmadi; Email: drnmmab@ 123456gmail.com
                Article
                EOR-21-0066
                10.1530/EOR-21-0066
                8897565
                35192506
                c73cff7d-33a9-4c9f-ac2e-16854d7f4694
                © The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Categories
                Hip
                hip, Hip
                developmental dysplasia hip
                acetabular dysplasia
                pelvic
                acetabular
                osteotomy
                subluxation
                dislocation
                Salter
                Pemberton
                Dega
                San Diego
                Custom metadata
                hip

                developmental dysplasia hip,acetabular dysplasia,pelvic,acetabular,osteotomy,subluxation,dislocation,salter,pemberton,dega,san diego

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