The Journal of Bone and Joint Surgery (American). 2005;87:254-259.
doi:10.2106/JBJS.D.02093
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in JBJS
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Clohisy, J. C.
Right arrow Articles by Schoenecker, P. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Clohisy, J. C.
Right arrow Articles by Schoenecker, P. L.
Related Collections
Right arrow Adult Hip
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Periacetabular Osteotomy for the Treatment of Severe Acetabular Dysplasia

John C. Clohisy, MD1, Susan E. Barrett, MD2, J. Eric Gordon, MD3, Eliana D. Delgado, MD4 and Perry L. Schoenecker, MD3

1 Washington University School of Medicine, 660 South Euclid, Campus Box 8233, St. Louis, MO 63110. E-mail address: jclohisy{at}msnotes.wustl.edu
2 Mulroy Orthopedic Surgery and Sports Medicine, 321 Fortune Building, 1st Floor, Milford, MA 01757
3 St. Louis Shriners Hospital for Children, 2001 South Lindbergh Boulevard, Saint Louis, MO 63131
4 400 Parnassus Avenue, Suite A311, San Francisco, CA 94117

Investigation performed at St. Louis Shriners Hospital for Children and Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The optimal treatment of severe acetabular dysplasia with subluxation of the femoral head or the presence of a secondary acetabulum remains controversial. The purpose of this study was to analyze the extent of surgical correction and the early clinical results obtained with the Bernese periacetabular osteotomy for the treatment of severely dysplastic hips in adolescent and young adult patients.

Methods: Sixteen hips in thirteen patients with an average age of 17.6 years (range, 13.0 to 31.8 years) were classified as having severe acetabular dysplasia (Group IV or V according to the Severin classification). Eight hips were classified as subluxated, and eight had a secondary acetabulum. Preoperatively, all patients had hip pain and sufficient hip joint congruency on radiographs to be considered candidates for the osteotomy. All sixteen hips underwent a Bernese periacetabular osteotomy, and six of them underwent a concomitant proximal femoral osteotomy. Postoperatively, the hips were assessed radiographically to evaluate correction of deformity, healing of the osteotomy site, and progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 4.2 years postoperatively.

Results: Comparison of preoperative and follow-up radiographs demonstrated an average improvement of 44.6° (from -20.5° to 24.1°) in the lateral center-edge angle of Wiberg, an average improvement of 51.0° (from -25.4° to 25.6°) in the anterior center-edge angle of Lequesne and de Seze, and an average improvement of 25.9° (from 37.3° to 11.4°) in acetabular roof obliquity. The hip center was translated medially an average of 10 mm (range, 0 to 31 mm). All iliac osteotomy sites healed. The average Harris hip score improved from 73.4 points preoperatively to 91.3 points at the time of the latest follow-up. Eleven of the thirteen patients (fourteen of the sixteen hips) were satisfied with the result of the surgery, and fourteen hips had a good or excellent clinical result. Major complications included loss of acetabular fixation, which required an additional surgical procedure, in one patient and overcorrection of the acetabulum and an associated ischial nonunion in another patient. Both patients had a good clinical result at the time of the latest follow-up. There were no major neurovascular injuries or intra-articular fractures.

Conclusions: The periacetabular osteotomy is an effective technique for surgical correction of a severely dysplastic acetabulum in adolescents and young adults. In this series, the early clinical results were very good at an average of 4.2 years postoperatively; the two major complications did not compromise the good clinical results.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?

Related articles in JBJS:

Periacetabular Osteotomy in the Treatment of Severe Acetabular Dysplasia
John C. Clohisy, Susan E. Barrett, J. Eric Gordon, Eliana D. Delgado, and Perry L. Schoenecker
JBJS 2006 88: 65-83. [Abstract] [Full Text]  



This article has been cited by other articles:


Home page
 JBJSHome page
J. C. Clohisy, R. M. Nunley, M. C. Curry, and P. L. Schoenecker
Periacetabular Osteotomy for the Treatment of Acetabular Dysplasia Associated with Major Aspherical Femoral Head Deformities
J. Bone Joint Surg. Am., July 1, 2007; 89(7): 1417 - 1423.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
C. L. Peters and J. Erickson
The Etiology and Treatment of Hip Pain in the Young Adult
J. Bone Joint Surg. Am., December 1, 2006; 88(suppl_4): 20 - 26.
[Full Text] [PDF]

Home page
 JBJSHome page
C. L. Peters, J. A. Erickson, and J. L. Hines
Early Results of the Bernese Periacetabular Osteotomy: The Learning Curve at an Academic Medical Center
J. Bone Joint Surg. Am., September 1, 2006; 88(9): 1920 - 1926.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. S. Kocher and D. J. Sucato
What's New in Pediatric Orthopaedics
J. Bone Joint Surg. Am., June 1, 2006; 88(6): 1412 - 1421.
[Full Text] [PDF]

Home page
 JBJSHome page
J. C. Clohisy, S. E. Barrett, J. E. Gordon, E. D. Delgado, and P. L. Schoenecker
Periacetabular Osteotomy in the Treatment of Severe Acetabular Dysplasia
J. Bone Joint Surg. Am., March 1, 2006; 88(1_suppl_1): 65 - 83.
[Abstract] [Full Text] [PDF]