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Effect of Innominate and Femoral Varus Derotation Osteotomy on Acetabular Development in Developmental Dysplasia of the Hip

¹ Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom. E-mail address for A. Roposch: a.roposch{at}ich.ucl.ac.uk
² Department of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada

Investigation performed at Great Ormond Street Hospital for Children, London; Institute of Child Health, University College London, London, England; and Hospital for Sick Children, Toronto, Ontario, Canada

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Arthritis Research Campaign. Neither they nor a member of their immediate families received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: Patients between fifteen months and four years of age with hip dislocations that were treated at two different centers were compared. At one center, open reduction combined with a femoral varus derotation osteotomy was performed (thirty-eight patients), and at the other, open reduction combined with an innominate osteotomy was performed (thirty-three patients). In each group, one surgeon performed all of the operations. A total of 490 postoperative radiographs that were made over a mean follow-up period of 6.2 years were analyzed. We compared the change in acetabular index as well as several other radiographic criteria of acetabular development and hip stability over time.

Results: After osteotomy, the acetabular index improved in both groups; however, the acetabular index in patients who underwent a varus derotation osteotomy never improved as much as that in patients who underwent an innominate osteotomy, with a mean difference of 9.5 after four years (p < 0.0001). Similarly, the innominate osteotomy group demonstrated better acetabular architecture and hip stability over time as quantified by the change in the acetabular floor thickness (p = 0.03), lateral centering ratio (p < 0.0001), and superior centering ratio (p < 0.0001).

Conclusions: In the present series, acetabular remodeling after open hip reduction and innominate osteotomy was more effective for reversing acetabular dysplasia and maintaining hip stability than open reduction combined with a femoral varus derotation osteotomy was. Long-term follow-up is necessary to determine whether the more favorable hip development following innominate osteotomy is associated with a lower incidence of premature degenerative hip disease.

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

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