B Heimkes1,2, F Schmidutz3,4, J Rösner3, V Frimberger5, P Weber3. 1. Klinik für Kinderchirurgie, Sektion Kinderorthopädie, Kliniken Dritter Orden gGmbH, Standort Klinikum Dritter Orden München-Nymphenburg, Menzinger Straße 44, 80638, München, Deutschland. bernhard.heimkes@dritter-orden.de. 2. Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland. bernhard.heimkes@dritter-orden.de. 3. Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland. 4. BG Trauma Center Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland. 5. Klinik für Kinderchirurgie, Sektion Kinderorthopädie, Kliniken Dritter Orden gGmbH, Standort Klinikum Dritter Orden München-Nymphenburg, Menzinger Straße 44, 80638, München, Deutschland.
Abstract
OBJECTIVE: The dysplastic acetabulum is shifted three-dimensionally outwards and forwards. INDICATIONS: Symptomatic residual hip dysplasias and hip subluxations in skeletally mature patients up to the age of 50 years. Sharp's acetabular up to 60°, as an exception above 60°. CONTRAINDICATIONS: Acetabular retroversion. Radiographic joint space at the lateral acetabular edge that is less than half the normal thickness for the patient's age. Relative contraindication: Elongated leg on the affected side. SURGICAL TECHNIQUE: Ilioinguinal approach in a supine position. Division of the innominate bone. Pivoting the distal osteotomy fragment outwards and forwards with the aid of the Salter maneuver. Fixing the fragments with a guide wire. Final correction of the osteotomy fragments. Force fitting of a dovetail grooved, wedge-shaped bone graft. Insertion of a cannulated compression screw and two further threaded rods. Wound closure. POSTOPERATIVE MANAGEMENT: Unloaded 3‑point walking for 4 weeks. Increasing weight bearing from week 4. Full weight bearing from week 10-12. RESULTS: A total of 45 consecutive patients (7 men, 38 women, 49 hips) underwent surgery. Average age at surgery was 27.6 years. The Sharp acetabular angle improved from preoperatively 45.7° ± 4.2° by 13.8° to 32.0° ± 6.4°; the Wiberg (LCE) angle increased from 15.4° ± 9.3° by 19.5° to 34.9° ± 10° postoperatively. The anterior center edge (ACE) angle increased from 28.9° ± 10.4° by 8.6° ± 2.3° to 37.5° ± 8.1°. Complications requiring surgical intervention occurred in 7 patients.
OBJECTIVE: The dysplastic acetabulum is shifted three-dimensionally outwards and forwards. INDICATIONS: Symptomatic residual hip dysplasias and hip subluxations in skeletally mature patients up to the age of 50 years. Sharp's acetabular up to 60°, as an exception above 60°. CONTRAINDICATIONS: Acetabular retroversion. Radiographic joint space at the lateral acetabular edge that is less than half the normal thickness for the patient's age. Relative contraindication: Elongated leg on the affected side. SURGICAL TECHNIQUE: Ilioinguinal approach in a supine position. Division of the innominate bone. Pivoting the distal osteotomy fragment outwards and forwards with the aid of the Salter maneuver. Fixing the fragments with a guide wire. Final correction of the osteotomy fragments. Force fitting of a dovetail grooved, wedge-shaped bone graft. Insertion of a cannulated compression screw and two further threaded rods. Wound closure. POSTOPERATIVE MANAGEMENT: Unloaded 3‑point walking for 4 weeks. Increasing weight bearing from week 4. Full weight bearing from week 10-12. RESULTS: A total of 45 consecutive patients (7 men, 38 women, 49 hips) underwent surgery. Average age at surgery was 27.6 years. The Sharp acetabular angle improved from preoperatively 45.7° ± 4.2° by 13.8° to 32.0° ± 6.4°; the Wiberg (LCE) angle increased from 15.4° ± 9.3° by 19.5° to 34.9° ± 10° postoperatively. The anterior center edge (ACE) angle increased from 28.9° ± 10.4° by 8.6° ± 2.3° to 37.5° ± 8.1°. Complications requiring surgical intervention occurred in 7 patients.
Entities:
Keywords:
Hip dislocation; Hip dysplasia; Hip joint; Pelvis; Surgical procedures
Authors: Florian Schmidutz; Johannes Roesner; Thomas R Niethammer; Alexander C Paulus; Bernhard Heimkes; Patrick Weber Journal: Orthop Traumatol Surg Res Date: 2018-06-07 Impact factor: 2.256
Authors: Clément M L Werner; Leonhard E Ramseier; Thomas Ruckstuhl; Jeff Stromberg; Carol E Copeland; Clifford H Turen; Kaspar Rufibach; Samy Bouaicha Journal: Skeletal Radiol Date: 2012-05-15 Impact factor: 2.199