Purpose. To evaluate the clinical and radiologic midterm results of rotational acetabular osteotomy (RAO) in incongruent hip joints. Material and Methods. A consecutive series of 15 hips in 14 patients who underwent RAO in incongruent hip joint were evaluated at an average follow-up of 52.3 months (range from 36 to 101 months). The average age at operation was 27 years (range from 12 to 38 years) old. The preoperative diagnoses were developmental dysplasia in 4 hips, sequelae of Legg-Calvé-Perthes disease in 8 hips, and multiple epiphyseal dysplasia in 3 hips. The RAO procedures were combined with a femoral valgus oseotomy in 10 hips, advance osteotomy of greater trochanter in 4 hips, derotational osteotomy in 2 hips. Clinically, Harris hip score, range of motion, leg length discrepancy(LLD) and hip joint pain were evaluated. Radiological changes of anterior and lateral center-edge(CE) angle, acetabular roof angle, acetabular head index(AHI), ratio of body weight moment arm to abductor moment arm, and a progression of osteoarthritis were analyzed. Results. The Harris hip score ha been improved from average from 67.5 points preoperatively to 97.6 points postoperatively. There have been no significant changes in the range of motion. The anterior CE angle increased from an average of 9.0°(-19.7□18.6°) to 32.5°(22.6□39.1°), the lateral CE angle from 7.6°(-12.1□14.1)° to 31.7°(26.5□37.8°) and the AHI from 61%(33□73%) to 86%(65□100%). The average ratio of body weight moment arm to abductor moment arm was changed 1.88 to 1.49. There was no case showing progression of osteoarthritis. None of the patients experienced revision surgery. Conclusion. The conventional salvage operation, such as Chiari osteotomy, has been recommended in incongruent hip. However, if we can expect to have a congruency after RAO with/without any femoral osteotomies, it would be a hopeful procedure for the incongruent joints by enhancing acetabular coverage, taking joint surface with normal articular cartilage, increasing abductor moment arm with additional improvement in LLD

Introduction and Objective. Several studies have described double and triple femoral neck lengthening osteotomies to correct coxa brevis deformity, however, no overview exists in literature. Our aim was to perform the first systematic review of the outcomes of double and triple femoral neck lengthening. Materials and Methods. After an extensive search in Pubmed, CINAHL and Embase libraries for published articles using the following search strategy: ‘(((proximal femoral deformity) OR hip dysplasia) OR coxa brevis) AND (((femoral neck lengthening) OR double proximal femoral osteotomy) OR triple proximal femoral osteotomy)’, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results. After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported. Conclusions. This first systematic review of double and triple femoral neck lengthening osteotomies shows that favorable outcomes and few complications can be expected in coxa brevis, however, excessive caution is required in older patients with incongruent hips

The senior author performed Kawamura Dome Chiari pelvic osteotomy on four patients with hip dysplasia, an incongruent hip joint and a weakly developed posterior wall that caused posterior instability. Although follow-up has not been long term, the uncomplicated postoperative course and improved hip stability of all four patients suggest that this operation offers a solution to a selected group of patients

The term of hip dysplasia means an abnormality of shape, size or spatial configuration of the acetabulum. It also concerns the femoral head, with mutual relationships, proportions and alignment between the femoral head and the acetabulum the most crucial factors. The reason of any symptoms in hip dysplasia is the dysplastic acetabulum and its disproportion in relation to the femoral head. Dysplasia of the acetabulum appearing at puberty has been attributed to secondary “absorption” of bony acetabulum. The presence of fatigue fractures at a later age has been considered as resulting from trauma. However, the fragments of the acetabular rim should be ascribed to overloading of the rim in dysplastic hips, causing fracture and separation of its segment. They are sometimes associated with cysts in the acetabular roof. Limbus tears with or without an associated bony fragment are known to occur after traumatic dislocation of the hip but also without any history of injury. There is no explanation of their cause or their relation to acetabular dysplasia. Limbus tears have been diagnosed by arthroscopy, arthrography and CT scans. Clinical signs. No hip dysplasia in adults is really symptom-free. A casual examination applied between the painful episodes may appear so normal, that the articular origin of the pain may be doubted. In most cases pain is elicited by passive movement of the thigh into full flexion, adduction and internal rotation. This combination of movements brings the proximal and anterior parts of the femoral neck into the contact with the rim of the acetabulum, exactly at the point where the labrum is likely to be damaged. Preop imaging. An anteroposterior radiograph, or “faux profil” view of Lequesne de Seze may demonstrate a congruent but short acetabular roof (Type II) or an incongruent hip with a shallow acetabulum and a more vertical than normal acetabular roof (Type I). Type I hip is potentially or really unstable. The femoral head has migrated laterally or anteriorly or in both directions, distorting the spherical shape of actebular inlet into an oval. A simple 3-dimensional classification is recommended by myself using conventional X-ray and CT scan on equatorial level. The CE angle and sectors angle acc. Anda are used to describe the anterior, lateral and posterior coverage. To check the possibilities of reduction, the anteroposterior radiograph is made in max. abduction of the hip. To simulate the correction movement of the acetabular part we use our own “Super pelvis” software. Intra-op control. For intraoperative correction control we use a C-arm, which also controls step by step all stages of the periacetabular osteotomy. To check the final correction the X-ray of both hips is absolutely obligatory. What we should check is: the displacement of the acetabular fragment (to avoid lateralization, if necessary to make medialisation) and the positions of the anterior and posterior acetabular rim. If this is impossible with the normal a-p X-ray, the C-arm is used for achieving the “faux profil”. The computer assisted orthopaedic surgery system appears the most accurate intra-op control