We conducted a retrospective audit of the short-term results of 14 patients with adolescent hip dysplasia treated with triple pelvic osteotomy. We compared our results with those in current international literature. The mean age of our patients at the time of surgery was 19 years (11 to 34). The mean follow-up period was 8 months. Preoperatively and postoperatively the patients were graded clinically by the modified Merle d’Aubigne and Postel systems. Radiological evaluation included the centre-edge (CE) angle of Wiberg, the acetabular index (AI) of Sharp and the percentage of femoral head cover. Patient satisfaction was graded out of five points. Clinically 86% of the patients exhibited improvement. The mean preoperative score was 12.3 (fair) and the mean postoperative score was 15.1 (good). Patient satisfaction was high, with a mean 4.75 out of 5 points. Radiologically there were notable improvements: the mean CE angle improved from 2° to 24°, the AI from 52° to 39°, and the percentage femoral head cover from 55% to 80%. Our results in this short-term study compare well with international results. The operation carries known long-term benefits in terms of biomechanics and delayed onset of OA

Aims

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

Purpose. Periacetabular osteotomy (PAO) is a versatile acetabular reorienting procedure that is most commonly used to provide greater femoral head coverage in adolescent hip dysplasia. However, PAO can also be used to reorient the acetabulum in the opposite direction to treat femoroacetabular impingement (FAI) due to acetabular over-coverage. We describe the indications, surgical technique, and early results of reverse PAO to reduce femoral head coverage in symptomatic hips with FAI due to acetabular over-coverage. Methods. IRB approval was obtained to retrospectively review cases of symptomatic acetabular over-coverage treated with reverse PAO and that had a minimum of two years follow-up. All hips had atypical intraoperative positioning of the acetabular fragment to uncover the lateral and anterior aspects of the femoral head, with or without anteverting the acetabulum. Prospectively collected pre- and post-operative demographics, WOMAC scores, Modified Harris Hip Score (MHHS), and radiographic measurements consisting of the lateral center edge angle (LCEA), Tönnis angle (TA), and anterior center edge angle (ACEA) were compared using student's t-test. Results. Between 2004 and 2015, 31 hips (18 left, 13 right) in 26 patients (18 female, 8 male) met the inclusion criteria. Average age at the time of surgery was 19.4 years. Average length of follow-up was 30.4 months. After reverse PAO, femoral head coverage significantly decreased (LCEA 41.7° to 35.3°, p<.001; TA −7.4° to −3.7°, p<.01; ACEA 44.0° to 35.3°, p<.0001). Patients experienced improved post-operative pain, with decreases in WOMAC pain score (from 8.8 to 4.2, p<.001) and WOMAC stiffness score (from 3.5 to 1.9, p<.001). Patients also experienced improvements in function and quality of life with improvements in WOMAC function score (from 24.8 to 10.0, p<.001) and MHHS (from 60.8 to 83.2, p<.0001). Conclusion. Reverse PAO is a technically challenging procedure that provides clinical and radiographic improvement in patients with symptomatic FAI due to acetabular over-coverage. Significance. Reverse PAO is an especially useful and appropriate alternative to arthroscopic acetabular rim-trim in complex FAI pathomorphologies

The June 2013 Children’s orthopaedics Roundup³⁶⁰ looks at: whether reaching a diagnosis is more difficult than previously thought; adolescent and paediatric DDH; the A-frame orthosis and Legg-Calvé-Perthes’ disease; failure of hip surgery in patients with cerebral palsy; adolescent rotator cuff injuries; paediatric peripheral nerve injuries; predicting residual deformity following Ponseti treatment; and the Dunn procedure.