J Korean Hip Soc.  2012 Mar;24(1):2-17. 10.5371/jkhs.2012.24.1.2.

Osteotomy around the Hip Joint

• Cho YJ
• Kwak SJ
• Kim HJ
• Lee SH

• KMID: 2014892
• DOI: http://doi.org/10.5371/jkhs.2012.24.1.2

Abstract

Hip joint preserving osteotomy surgery is the treatment of choice for young patients with early symptomatic structural abnormalities of the acetabulum and proximal femur. This is true even in the absence of severe secondary degenerative changes. These disorders can include hip instability from classic developmental dysplasia, post-traumatic acetabular dysplasia, hip impingement from retrotorsional acetabular deformities, or, rarely, post-traumatic problems. During the past 20 years, various techniques of acetabular and proximal femoral reorientation have evolved, making the procedure reliable, reproducible, and durable. In this report, the current indications and results of acetabular and proximal femoral osteotomies in patients with symptomatic acetabular structural problems will be discussed.

Keyword

Hip; Osteotomy; Joint preservation

MeSH Terms

Acetabulum
Congenital Abnormalities
Femur
Hip
Hip Joint
Humans
Osteotomy

Figure

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  Fig. 1 Classification of reconstructive osteotomy according to osteotomy site.

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  Fig. 2 Approach of rotational acetabular osteotomy. The approach combines the anterior iliofemoral and posterior approaches through a single skin incision.

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  Fig. 3 Schematic drawing of the operative procedure. The freed acetabulum should be shifted anterolaterally, medially, and downward. (A) Preoperative view, (B) anterolateral shift, (C) downward and medial shift after removal of the excess bone.

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  Fig. 4 Transpositional osteotomy. Rotation of acetabulum is focused on anterior rotation.

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  Fig. 5 Bernese periacetabular osteotomy. (A) External surface, (B) Internal surface.

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  Fig. 6 A Kirshner wire or Steinmann pin is inserted as a guide at the middle of the superior acetabular rim at the proposed level and angle.

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  Fig. 7 The line of osteotomy which is marked by multiple drill holes.

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  Fig. 8 The ideal level of osteotomy is just above the capsular attachment between the capsule and the reflected head of rectus femoris. The osteotomy angle is the angle between the plane of the pelvic osteotomy and the horizontal(10 to 15 degrees upward and medially). The roof angle is the angle formed between the horizontal and a line joining the original outer acetabular lip to the new acetabular lip.

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  Fig. 9 Varus femoral osteotomy (A) Pauwel, (B) Müller, (C) Nishio.

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  Fig. 10 Postoperation malpositioned mechanical axis is a possible problem after femoral osteotomy, standing weight bearing lower extremity radiologic evaluation should be excuted. In the case of valgus osteotomy for varus deformity, changes of body weight bearing axis after operation should be prevented through external access of distal extremity after osteotomy.

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  Fig. 11 Illustration of preoperative templating method.

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  Fig. 12 Radiograph of the left hip who had steroid-associated osteonecrosis of the femoral head following curved intertrochanteric varus osteotomy.

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  Fig. 13 The operation is carried out through the straight lateral incision. (A) Two Kirschner wires are inserted superiorly parallel to the femoral neck. (B) The base of trochanter is divided in line with upper border of Kirschner wires and mobilized from the distal soft-tissue attachment. A thin wedge of bone is then removed from the proximal lateral aspect of femoral cortex. (C) The greater trochanter is transferred distally and laterally and fixed with two 6.5-mm cannulated screws.

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  Fig. 14 Ganz's surgical dislocations. Incision is centered over the greater trochanter and angulated slightly posteriorly. A trochanteric slide osteotomy is performed with a small sleeve of the gluteus medius left attached and with the vastus lateralis left attached to the trochanteric fragment. The osteotomy must be extracapsular and lateral to the piriformis fossa to avoid damage to the blood supply. The trochanteric slide osteotomy is mobilized anteriorly and the femoral head is dislocated anteriorly.

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  Fig. 15 Transposition of necrotic focus of femoral head anteroinferiorly away from weight bearing area as a result of anterior rotation of head.

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