Periacetabular osteotomy has been described as an effective way of treating symptomatic hip dysplasia. We describe a new minimally invasive technique using a modification of the Smith Peterson approach. 189 consecutive patients operated on between March 2010 and March 2013 were included in the study. Patients who had undergone previous pelvic surgery for DDH were excluded. There were 174 females and 15 males. The mean age was 31 years (15–56) and the mean duration of follow-up was 29 months (14 – 53 months). 90% of cases were Tonnis grade 0 or 1. Twenty-three patients were operated on for primary acetabular retroversion. Functional outcomes were assessed using the NAHS, UCLA and Tegner activity scores. The surgical procedure is performed through an 8–10 cm skin crease incision; a soft tissue sleeve is elevated from the anterior superior iliac spine. The interval medial to the rectus femoris is developed. The hip joint is not opened and fixation of the osteotomy was with three 4.5mm cortical screws. A cell saver was routinely used.Introduction
Patients/Materials & Methods
The cam-type deformity in femoroacetabular impingement
is a 3D deformity. Single measurements using radiographs, CT or
MRI may not provide a true estimate of the magnitude of the deformity.
We performed an analysis of the size and location of measurements
of the alpha angle (α°) using a CT technique which could be applied
to the 3D reconstructions of the hip. Analysis was undertaken in
42 patients (57 hips; 24 men and 18 women; mean age 38 years (16
to 58)) who had symptoms of femoroacetabular impingement related
to a cam-type abnormality. An α° of >
50° was considered a significant
indicator of cam-type impingement. Measurements of the α° were made
at different points around the femoral head/neck junction at intervals
of 30°: starting at the nine o’clock (posterior), ten, eleven and
twelve o’clock (superior), one, two and ending at three o’clock
(anterior) position. The mean maximum increased α° was 64.6° (50.8° to 86°). The two
o’clock position was the most common point to find an increased α°
(53 hips; 93%), followed by one o’clock (48 hips; 84%). The largest α°
for each hip was found most frequently at the two o’clock position
(46%), followed by the one o’clock position (39%). Generally, raised α angles
extend over three segments of the clock face. Single measurements of the α°, whether pre- or post-operative,
should be viewed with caution as they may not be representative
of the true size of the deformity and not define whether adequate
correction has been achieved following surgery. Cite this article:
The Stoppa approach was originally conceived to deal with difficult abdominal hernia surgery. Its use has been modified to deal with Acetabular and Pelvic surgery. We report on our use of the Stoppa approach in 26 cases from 1998–2003 to fix Pelvic, Acetabular, and combined Pelvic/Acetabular fractures. The Stoppa approach was used in combination with other approaches to afford the best access for fixation. 11 of the cases were Acetabular fractures with no pelvic ring disruption (42.3%), 4 cases (15.3%) were pelvic ring disruptions without an Acetabular component. The other 11 cases (42.3%) were combined Pelvic and Ace-tabular fractures where this approach came into its own. In particular it is to be noted that the Corona Mortis was easily identifiable in 5 (19.2%) of the cases to allow its safe ligation. The anatomy of the approach and the access afforded are considered, along with the plating techniques that can be achieved because of its use. Patients were followed up for an average of 17.39 months with one lost to follow up. Clinical results were excellent in 20 cases, good in 2, fair in 2, and poor in 1. Complications were lateral femoral cutaneous nerve palsy in 11 patients, 1 bladder rupture, 2 superficial wound infections, one lateral incisional hernia related to an ilioinguinal approach, and 1 deep vein thrombosis. Heterotopic Ossification occurred in 3 patients in whom the Kocher-Langenbeck approach was used. One revision for screw proximity to the joint was undertaken. The Stoppa approach allows safe access and ease of reduction and fixation in these complex fractures, in combination with other approaches, particularly in combined pelvic and Acetabular fractures. We outline our recommendations for its use in this paper and outline a series of fracture patterns where it is most helpful.
