J Korean Orthop Assoc.  2008 Dec;43(6):718-727.

Periacetabular Osteotomy in Hip Dysplasia with Deformed Femoral Head

• Chang JS
• Oh HK
• Kim JW
• Hong SH

Abstract

PURPOSE: To evaluate the results of a periacetabular osteotomy (PAO) combined with a femoral osteotomy (FO) for a dysplastic hip with a deformed femoral head.
MATERIALS AND METHODS
Thirteen hips with dysplasia and a deformed femoral head were followed up for more than 12 months. Eight hips were in the PAO group and 5 hips were in the PAO and FO group. The two groups were compared clinically according to the HHS (Harris hip score), pain and limping VAS (visual analogue scale), and radiologically according to the CEA (central edge angle of Wiberg), Tonnis angle (acetabular index of weight bearing surface), FHC (femoral head coverage), AA (acetabular angle of Sharp), DBSPFH (distance between symphysis pubis and femoral head) and AI (acetabular index of depth to width).
RESULTS
Regarding the clinical results, the PAO group showed improvement in the HHS from 66.5 preoperatively to 90.4 postoperatively (p=0.01) and the pain VAS from 6.7 to 1.9 (p=0.01). However, there was no significant improvement in limping (p=0.39). In the PAO with FO group, the HHS was improved from 78 to 91 (p=0.04). Radiologically, the CEA, Tonnis angle, FHC, AA and AI improved significantly but there were no significant improvement in the DBSPFH in the two groups. In addition, there was no significant clinical or radiological difference between the two groups.
CONCLUSION
Periacetabular osteotomy is recommended for dysplastic hips with deformed femoral head. A concomitant femoral osteotomy should be considered in hips with a severely deformed femoral head.

Keyword

Pelvis; Acetabulum; Dysplastic hip; Periacetabular osteotomy; Femoral osteotomy

MeSH Terms

Acetabulum
Head
Hip
Osteotomy
Pelvis
Weight-Bearing

Figure

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  Fig. 1 Radiologic evaluations of the dysplastic hip. For the evaluation of coverage of femoral head, CE angle (CEA), Tonnis angle and femoral head coverage (FHC) were checked. To evaluate the inclination and depth of acetabulum, acetabular angle of Sharp (AA) and AI(acetabular index of depth to width). Finally to check the medialization of the femoral head, the distance between symphysis pubis and the femoral head was compared.

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  Fig. 2 Preoperative planning for periacetabular osteotomy and proximal femur osteotomy.

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  Fig. 3 Diagram of the dual approach. Anterior approach is modified Smith-Peterson approach and posterior approach is Kocher-Langenbock approach.

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  Fig. 4 41-year-old male patient with acetabular dysplasia. (A) Preoperative radiograph shows deformed femoral head, inclination of acetabulum and shollow acetabular coverage due to LCP sequelae. (B) MR arthrogram shows the labral tear of the acetabulm due to load concentration. (C) Postoperative radiograph shows excessive correction after periacetabular osteotomy. (D) Excessive retroversion of the acetabulum after periacetabular osteotomy which has caused impingement during hip flexion. Preoperatively the patient could flex the hip upto 130 degrees and sit on the posture of crossing both legs. As result of excessive retroversion, the patient can flex the hip upto just 110 degrees and have to sit unfolding the leg.

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  Fig. 5 (A) 25-year-old female patient who has acetabular dysplasia with deformed femoral head and coxa valga deformity. Preoperative anteroposterior radiographs in abduction and adduction position demonstrate the acceptable coverage and congruency in abduction position. (B) Postoperative radiograph shows satisfactory correction after periacetabular osteotomy and varus osteotomy of the proximal femur.

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