DECENTERED DYSLASTIC HIP JOINTS IN ADOLESCENTS AND ADULTS: ALGORITHM OF TRIPLE PELVIC OSTEOTOMY PLANNING AND THE RESULTS OF TWELVE SPECIAL CASES

Abstract

Purpose: Adolescents and adults with decentered hip joints in DDH frequently suffer from moderate to severe pain frequently or exclusively during daily physical activity or sports activity. Especially power walking, running, walking downhill provoke pain in the thigh area.

Materials and Methods: Since 1993 we perform a triple pelvic osteotomy according to Tönnis in patients with typical DDH - related clinical findings and overlook 138 operated patients. The operation is not performed in hips with moderate or severe degenerative changes. Depending on the hip joint geometry in some cases of a decentered hip joint an osteotomy of the proximal femur is performed additionally. Concise patient questionnaires, special clinical tests and different types of radiographic examinations lead to the correct indication.

Results: In this special report we present the pre- and postoperative clinical findings, conventional x-rays, CT scans and MRI specific findings of 12 dysplastic, decentered hip joints from our patient collective of 110 patients. All six patients were female, the mean age at the time of the procedure was 33 years. At time of the last follow up examination all patients were satisfied with the postoperative result and no hip had to be converted to a total hip arthroplasty. The retrospective examination shows that in patients with a typical case history, distinct clinical findings and DDH signs in conventional x-rays the mentioned procedure can be correctly indicated by plain x-ray studies. In complex cases (e. g.: decentered hip joints, reduced acetabular antever-sion or reduced femoral antetorsion, tears of the labrum acetabulare) additional studies such as CT-Scans, MRI Scans or MR Arthrographies need to be performed. In suspected deformities of the proximal femur standard conventional x-rays to evaluate the femoral antetorsion (“Rippstein”) or axial projections (“Lauenstein”) to identify “bump” osteophytes have to be performed.

Conclusion: The classification of DDH-related symptoms is correctly done by an exact clinical examination in combination with the above mentioned conventional x-rays, CT-Scans (eventually combined with a 3D reconstruction), MRI-Scans and MRI-arthrographies. In this presented small patient collective no hip had to be converted to a total hip arthroplasty in spite of the fact that all hips were decentered.