TRIPLE PELVIC OSTEOTOMY – TEN YEARS EXPERIENCE

Abstract

When surgical treatment of dysplastic hip and hip joint incongruence in adolescence is necessary, triple pelvic osteotomy is preferable to other types of pelvic osteotomies (even when they are associated with femoral ones). We evaluated our ten years long experience with the mentioned method.

We treated 78 hips (67 patients) with Tonnis-Vladimirov triple pelvic osteotomy between 1996 and 2005. Average age of our patients was 15 years and 6 months. The patients were followed for mean 39 (17–133) months. In 2 hips triple pelvic osteotomy was associated with femoral corective osteotomy, in one hip with femoral corective osteotomy and open reduction, and in 7 with the translocation of the greater trochanter.

Treatment results were evaluated, both anatomically and functionally. Anatomic improvement was detected by measuring CE angle of Wiberg. It improved from an average of 16,1 – to 43,1 degrees – the difference has proven to be statistically highly significant. Functional improvement (absence of waddling gate or limp; as well as better range of motion) was noticed in almost all the cases. The improvement was accompanied by spatial reorientation and correction. Major complications included asymptomatic pubic and/or ischial osteotomy nonunions in seven patients.

We found good radiographic correction of deformities and improvement of hip function with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of acetabular dysplasia and hip joint incongruence in patients older than 8–10 years. It may prevent and postpone the development of secondary osteoarthrosis.