Supratrochanteric osteotomy of the hip in adults with dysplastic coxarthrosis]

On the basis of complex assessment of the results of supratrochanteric osteotomy of pelvis (30 operations) and osteotomy of pelvis with the subsequent intertrochanteric osteotomy (24 observations) in patients with dysplastic coxarthrosis at mean terms of observation, equalling to 90 months, have been determined efficiency and indications for these operations. Indications for pelvic osteotomy are formed on the basis of roentgeno-anatomic interrelations in hip joint, where the decisive part is played by the angle of vertical inclination of the cotyloid cavity and degree of coating of the head of the femur. Intertrochanteric osteotomy following the pelvic osteotomy is indicated at preserved pain syndrome, resulting from coxarthrosis, subsequent to the muscular system restoration.     

Dome osteotomy of the pelvis using a modified trochanteric osteotomy for acetabular dysplasia

Purpose  

Kawamura described his dome osteotomy of the pelvis using a standard trochanteric osteotomy. Here we present results of our modification of Kawamura's dome osteotomy using a modified trochanteric osteotomy.     

Exstrophy of the bladder: primary closure after iliac osteotomies without external or internal fixation.

A total of 6 consecutive infants with exstrophy of the bladder underwent iliac osteotomy in association with primary closure of the bladder without internal or external fixation of the bony pelvis. Hospitalization time was short and there were no resulting problems with healing, bony deformities or subsequent ambulation. Fixation of the bony pelvis after iliac osteotomy does not appear to be necessary in nonambulatory patients undergoing primary closure for bladder exstrophy.     

Effect of derotation osteotomy of the femur on hip and pelvis rotations in hemiplegic and diplegic children

The purpose of this study was to evaluate hip and pelvis rotations in groups of hemiplegic and diplegic children before and after surgical correction of fixed internal rotation deformity of the hip. Twenty-two children with cerebral palsy (eight diplegia, 14 hemiplegia) having fixed internal rotation deformity at the hip were treated by multilevel surgery which included derotation osteotomy of the femur. Evaluation was done before and at a mean of 3.1 years after surgery using three-dimensional computerized gait analysis. Preoperatively, the patients in the hemiplegia group had a significantly greater compensatory external rotation of the pelvis than those in the diplegic group. Post-operatively there were no significant differences between the two groups. In the hemiplegia group the external rotation of the pelvis was corrected after correction of hip rotation by derotation osteotomy. Patients in the diplegia group showed significant improvements in the hip rotation with no significant change in the pelvis rotation after multilevel surgery.     

Osteotomy and distraction of the anterior segment of the pelvic ring in epispadias repair: case report.

We report a new therapeutic approach for bladder exstrophy and epispadias in one case of failed epispadias repair. The width of the pelvis was measured by what we defined as the anteroposterior diameter (APD) on combined transverse computed tomography (CT) scan cuts of the pelvis. The APD was half the normal value in an incontinent patient with failed epispadias repair. He underwent a supraacetabular osteotomy of the pelvis with progressive anterior distraction of the anterior segment of the pelvic ring. Four months later, hardware was removed, and the APD was near normal value. Within 9 months of follow-up, the patient was dry day and night. We believe that in patients with failed exstrophy and epispadias repair, APD seems to be a predictive criterion for continence, and results of the reconstructive surgery with osteotomy should be improved by distraction of the anterior segment of the pelvic ring.     

Osteotomie als Zugang

Autologous bone transplants are still the gold standard for defect filling materials and no other material has such a high biological potential. Proven surgical techniques for harvesting cancellous and cortical autografts in the pelvis, the problems and complications are described. The second part of the paper explains the safe handling of osteotomy of the superior anterior iliac spine for pelvic osteotomy and tumor surgery.     

Case of bilateral obturator neuropathy after caesarean section

We describe a case of bilateral obturator neuropathy after caesarean section. A 33-year-old woman expecting her first baby had rotational acetabular osteotomy 8 and 9 years ago. After the surgery, she complained of weakness in the lower limbs and diagnosed as bilateral obturator neuropathy by orthopedist. Rotational acetabular osteotomy is known as one of the causes of narrow mid-pelvis diameter and it raises probability of caesarean section. Contracted pelvis may cause obturator neuropathy after delivery and we need to exclude complications by epidural blockade.     

Total hip replacement with and without osteotomy of the greater trochanter. Clinical and biomechanical comparisons in the same patients

Twelve patients with bilateral hip replacement, one side performed with a trochanteric osteotomy and the other without osteotomy, were analyzed by review of the clinical records, the findings on physical examination, preoperative and postoperative Harris hip scores, each patient's evaluation, biomechanical analysis of the preoperative and postoperative roentgenograms of the hips and pelvis, and force-plate gait analysis. All operations yielded good results clinically but the majority of patients preferred the replacement done without osteotomy. Blood loss and trochanteric bursitis were greater problems in patients who had an osteotomy. There were no differences between the two groups in the postoperative Harris scores or in the biomechanical measurements made on the preoperative and postoperative roentgenograms except for the change in the abductor-muscle length. Changes in this parameter correlated well with the patients' symptoms and clinical findings.     

The assessment of contact stress in the hip joint after operative treatment for severe slipped capital femoral epiphysis

We determined contact stress on the articular surface of the hip joint in a group of patients who underwent operative treatment for severe slipped capital femoral epiphysis. Two different procedures were considered: the modified osteotomy of Dunn-Fish and the osteotomy of Imh?user. In order to determine the stress distribution, a three-dimensional mathematical model was used taking into account the geometrical parameters of the pelvis and hip, which were measured from standard antero-posterior radiographs. We found that the Dunn-Fish procedure produced lower peak stress than the Imh?user procedure.     

Chiari osteotomy of the pelvis: a long-term study

We evaluated 104 osteotomies of the pelvis after an average of 18 years: 48% of patients had hip joint pain, 15% had low back pain, 41% had restricted movement, 74% had a positive Trendelenburg sign, and 77% had limb length discrepancy greater than 1 cm. We also followed the anti-Chiari effect, the influence of the osteotomy on narrowing the birth canal, and deterioration of the opposite acetabulum. We showed that the optimum indications for Chiari osteotomy are severe instability of the hip joint and an irregular femoral head.     

髂骨延长骨盆钉内固定术的意外处理

本文对儿麻后遗症肢体短缩畸形患者，行骨盆截骨延长时，采用自行设制的“骨盆支撑内固定钉”进行内固定；着重对该手术可能发生的意外进行了分析探讨，并对原因，提出了具体的处理方案，避免了手术的并发症，提高了手术疗效。     

Magnetic resonance imaging pelvimetry before and after a periacetabular osteotomy

BACKGROUND: The majority of patients who undergo a reconstructive pelvic osteotomy because of symptomatic hip dysplasia are young women of childbearing potential. The purpose of this paper was to evaluate the effect of periacetabular osteotomy on the dimensions of the pelvic inlet and outlet in these patients. METHODS: The dimensions of the osseous pelvis of seven women with symptomatic hip dysplasia were measured with use of magnetic resonance imaging pelvimetry before and after periacetabular osteotomy. Four measurements were made: the bispinous diameter, the anterior-posterior inlet measurement, the anterior-posterior midpelvis measurement, and the transverse inlet measurement. Radiographic correction obtained with the osteotomy was documented with preoperative and postoperative anteroposterior pelvic and false-profile radiographs. RESULTS: Periacetabular osteotomy improved the T nnis angle and the Lequesne angle of the hip joint to an average of 8 degrees and 30 degrees, respectively. The hip center of rotation was medialized an average of 8 mm. None of the four measurements made with the magnetic resonance imaging pelvimetry decreased substantially after the periacetabular osteotomy. CONCLUSION: Periacetabular osteotomy does not markedly alter the pertinent pelvic dimensions in young female patients.     

The surgical treatment of inveterate hip dislocation in children affected with cerebral palsy: a preliminary report

The incidence of hip dislocation in patients affected with cerebral palsy is directly correlated with the degree of neurologic deficit. Surgical treatment aimed at stabilization of the coxofemoral joint relieves pain and avoids the occurrence of changes in the static of the pelvis and vertebral column. The authors report their experience with procedures for the recovery of joint congruency (release of the adductors and psoas, surgical reduction of the dislocated epiphysis, femoral shortening associated with varus-derotation at the osteotomy level, acetabuloplasty) performed in one or more surgical stages, and operations with a purely anthalgic purpose (innominate osteotomy according to Chiari), specifying relative indications in relation to age.     

Premature closure of the triradiate cartilage: a potential complication of pericapsular acetabuloplasty

A case of premature triradiate cartilage closure secondary to a Gill acetabuloplasty performed at age 14 months is reported. The deficiency in acetabular development and failure of the pelvis to grow to its anticipated height is documented. A proximal femoral redirectional osteotomy and an innominate osteotomy performed near maturity improved femoral head coverage and hip biomechanics. Acetabuloplasties performed adjacent to the triradiate cartilage typically do not have any adverse effect on its function. Despite this low risk of injury to the triradiate cartilage after a Gill or Pemberton acetabuloplasty, long-term follow-up is recommended to observe acetabular development. Premature closure is most likely to occur if the bone graft used to maintain fragment displacement crosses the triradiate cartilage.     

Prophylaxis with indomethacin for heterotopic ossification after Chiari osteotomy of the pelvis.

One hundred patients who had painful dysplasia of the hip were treated with a Chiari osteotomy of the pelvis, and the postoperative radiographs were reviewed for the development of heterotopic ossification. Sixty patients did not receive indomethacin postoperatively, and eighteen (30 per cent) had heterotopic ossification of at least class 1; forty patients received indomethacin for two weeks postoperatively, and only three (8 per cent) of them had heterotopic ossification. This difference was significant (p < 0.025). No class-3 or 4 heterotopic ossification was seen in the patients who were given indomethacin. The prevalence of side-effects was relatively low, and no delayed union of the osteotomy was observed in any patient. We concluded that indomethacin, in the dosage schedule and regimen that we used, provides effective prophylaxis for heterotopic ossification after a Chiari pelvic osteotomy.     

Surgical treatment of developmental dysplasia of the hip in adults: I. Nonarthroplasty options

Hip dysplasia is a developmental disorder that results in anatomic abnormalities leading to increased contact pressure in the joint and, eventually, coxarthrosis. However, many patients with hip dysplasia become symptomatic before the development of severe degenerative changes because of abnormal hip biomechanics, mild hip instability, impingement, or associated labral pathology. Several nonarthroplasty treatment options are available. Because the primary deformity is mostly acetabular, for many patients, a reconstructive osteotomy that restores more nearly normal pelvic anatomy is preferable. The Bernese periacetabular osteotomy is presently favored because it provides good correction while creating little secondary pelvic deformity or destabilizing the pelvis. Proximal femoral osteotomy is occasionally needed as a complement to pelvic osteotomy and may also be indicated as an isolated procedure when most deformity is located on the femoral side (coxa valga subluxans). Arthroscopy can be beneficial when symptoms seem to be related only to labral tears or loose bodies in the absence of severe structural abnormalities about the hip. Fusion and resection arthroplasty are rarely indicated and are reserved for occasional patients who are not candidates for total hip replacement or other procedures but who complain of refractory hip pain.     

Indikation und Ergebnisse von Acetabuloplastik und Beckenosteotomie nach Chiari bei angeborener Hüftgelenksdysplasie

Zusammenfassung An Hand des Krankengutes der Orthopädischen Universitätsklinik München wurden die Indikationen zur Acetabuloplastik und Beckenosteotomie gegeneinander abgegrenzt. Bewertet wurden 178 Verlaufsserien von prä- und postoperativen Röntgenkontrollen operierter Hüftdysplasien. Durch dieBeckenosteotomie nach Chiari lassen sich vor allemSubluxationsstellungen descoxalen Femurendes beigleichzeitiger seichter, steiler undkurzer Pfannenanlage wirkungsvoll ausgleichen; Hauptindikationsbereich der Acetabuloplastik scheint hingegen die steile, langgestreckte Pfanne, während bei vermehrter Subluxation die Resultate hier nicht immer primär befriedigen. Im wesentlichen ist die Indikation für eine der beiden Eingriffeweniger altersbedingt, sondern vielmehr durch die vorliegendenanatomischpathologischen Verhältnisse abzugrenzen.

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Acetabuloplasty and osteotomy of the pelvis (chiari). indication and operative results in dysplastic hips

Summary The indications for acetabuloplasty and osteotomy of the pelvis have been defined according to 178 follow-up series of pre- and postoperative X-ray controls of dysplastic hip joints which had been operated in the Orthopedic Hospital of the University of Munich. Especially incomplete dislocations of the upper end of the femur combined with a shallow, steep and short acetabulum can be corrected by Chiari's osteotomy of the pelvis with good results. The acetabuloplasty seems to be mainly indicated for the steep, extended acetabulum whereas in more distinct subluxation the results do not always satisfy initially. The indication for one of these two operations is determined more by the anatomic-pathological conditions than by the age of the patient.

     

Triple osteotomy of the pelvis for acetabular dysplasia: age at operation and the incidence of nonunions and other complications influence outcome

We investigated the variables which determine the outcome after triple osteotomy of the pelvis for the treatment of congenital dysplasia of the hip. We reviewed 51 patients (61 hips) with a median age at operation of 23 years who were treated with a T?nnis triple osteotomy. The median follow-up was six years with a minimum of two years. Eight patients (eight hips) required a revision procedure. Of the remaining 53 hips, the results were good or excellent in 36 (68%) when evaluated according to the Harris hip score (median 90 points), and 33 patients (65%) were satisfied with the procedure. Logistic regression analysis indicated that the incidence of complications such as nonunion at an osteotomy site influenced patient satisfaction (p = 0.079). The incidence of complications correlated positively with increasing patient age at operation (p = 0.004). The amount of acetabular correction did not correlate with patient satisfaction. In univariate analysis, the groups of 'satisfied' and 'not satisfied' patients differed significantly in Harris hip score, age, incidence of nonunion at the osteotomy sites, complications and late revisions. In conclusion, the patient's age at operation and the incidence of complications influence patient satisfaction after triple osteotomy, but the amount of radiologically evident acetabular correction shows no correlation to outcome.     

Triple osteotomy of the pelvis. A review of 51 cases

From 1980 to 1987, 43 patients (51 hips) were treated by triple pelvic (ischium, ilium, and pubis) osteotomy for moderate to severe symptomatic acetabular dysplasia. They were followed postoperatively for an average of 48 months (range, 18 to 84 months). In 41 patients (43 hips; 96%) there was dramatic relief of pain. The mean center-edge angle improved from 13.4 degrees to 36.1 degrees. The coverage of the femoral head was improved by an average of 25%. The authors conclude that triple osteotomy of the pelvis gives consistently good and predictable results with regard to pain relief and adequate femoral head coverage.     

Salter截骨联合股骨转子下截骨对髋关节发育的影响

目的探讨Salter截骨联合股骨转子下截骨对髋关节发育的影响。方法对51例（59髋）发育性髋关节发良不良行Salter截骨联合股骨转子下旋转、短缩截骨治疗。测量术前、术后X线片臼头指数、CE角、髋臼指数、患、健侧股骨头骨化中心直径比率（FHDR）,比较术前、术后变化。结果随访1～5年,经Salter截骨联合股骨转子下旋转、短缩截骨治疗后,臼头指数、CE角、髋臼指数及患、健侧FHDR都有明显改善,尤其是在术后2～3年变化最为显著。疗效：优66.1%（39/59）,良27.1%（16/59）,可6.8%（4/59）,优良率93.2%。结论Salter截骨联合股骨转子下截骨是一种早期治疗发育性髋关节发育不良疗效良好、可靠的手术方法。