Abstract
Purpose: Kotz osteotomy (polygonal pelvic osteotomy) is performed for hip dysplasia especially with deficient acetabular coverage . One of the important problems of this osteotomy is Trendelenburg limping due to detachment of abductor muscles from their origin at the iliac bone during the surgical approach. In order to solve this problem, the surgical approach of Kotz osteotomy was modified and iliac osteotomy was made from the medial side of iliac bone instead of lateral side without detaching the abductor muscles and two skin incision were used instead of three skin incisions. We present the results of nine hips in seven patients who were operated using this modified surgical approach.
Materials and Methods: In this study, CE angle, VCE angle, Sharp angle, Harris hip score, trendelenburg test, and abductor muscle strength (at first and third postoperative monts) of nine hips of seven patients (6 female, 1 male and mean age 19.2 year) who underwent the modified surgical approach were evaluated.
Results: Preoperative average CE angle, VCE angle, Sharp angle and Harris hip score were −0.22°(−9 to 13°), 8.22°(−13 to 20°), 53.11°(44 to 58°), and 63.55(51 to 71), respectively. Trendelenburg test was positive in 7 of 9 hips. The mean follow-up time is 6.5 months (3 to 17 months). Postoperatively, average CE angle, VCE angle, Sharp angle and Harris hip score were measured 33.66°(12 to 54°), 36.00°(18 to 51°), 34.33°(26 to 54°), and 91.66(74 to 100), respectively and there was statistically significant difference (p< 0.05). Trendelenburg’s test was negative in 8 of 9 hips postoperatively. The abductor muscles strength was measured clinically and was determined 3.4/5 at first and 4.2/5 at third postoperative month. Union was achieved at all osteotomy sites . In the postoperative period, in one hip, positive Trendelenburg test was continued because of inadequate coverage and superior migration of the femoral head.
Conclusions: This modified Kotz osteotomy achieves adequate acetabular coverage as the original technique and furthermore it provides recovery of abductor muscle strength in the early postoperative period and decreases the rate of Trendelenburg limping.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
