Improvement in coverage achieved by double or triple osteotomies is limited by the size of the acetabular fragment and the ligaments connected with the sacrum. Correction is achieved with the notable asymmetry of the pelvis. In periacetabular Ganz osteotomy (PAO) the acetabular fragment has no connection with the sacrum, which creates enormous possibilities for correction, leaving the pelvic ring untouched.

The aim of the study is to present our experience and early results of using PAO in the treatment of hip dysplasia in adolescents and young adults who were previously treated operatively in childhood, and to find the technical and clinical impact of previous operations on our Results: In the years 1998–2005 262 periacetaubular osteotomies were performed in our hospital. All the patients were operated by one surgeon (JC). From this group 41 patients (43 hips) had previously been operated in childhood for the treatment of hip dysplasia. The previous treatment consisted of: open reduction in 10 hips, DVO in 14 hips, pelvic osteotomy (Salter, Dega, Chiari) in 8 hips, combined: open reduction+DVO+pelvic osteotomy in 10 hips, greater trochanter transfer in 3 hips, bone lengthening in 4 hips, acetabular cyst removal in 1 hip. The age at the primary operation ranged from 1–20.. The follow-up period ranged from 1–7,5 ys av. 2 ys.

In 31 hips the Smith-Petersen, and in 12 hips ilioinguinal approach were performed.

Methods. In clinical pre-op, and post-op examination the following factors were considered: pain, limping, Trendelenburg sign, range of motion, length discrepancy. Radiographic pre-op and post-op examination consisted of: AP view of the pelvis, false profile and AP view with the leg in abduction. Classic and anterior CE angle were measured. During the last examination Harris Hip Score was used.

Results. Flexion slightly decreased from pre-op. 90–140° (av. 118°) to 80–130° (av. 104°) post-op. abduction remained unchanged 15–60° (av. 40°) and 15–60° (av. 40°) respectively, adduction slightly increased 15–40° (av. 31) and 20–50° (av. 33°). The range of rotation did not change after the operation. The sign of Trendelenburg was found in 27 hips before operation and in 8 hips post-op. Pain (acetabular rim syndrome) was found in 40 hips before operation and in 4 hips after the surgery. Either classic or anterior CE angle increased after the surgery in all cases from −14° to 34° and from −10° to 35° respectively. We had a rather low complication rate. But in cases previously operated and in males we strongly recommend Smith-Petersen approach extended into the frontal part of the hip for a better exposure in the scarred and hardened tissues.

We find the technique of PAO as a safe, and effective tool for treating hip joint pathology increasing treatment possibilities for hip joint preservation.

Introduction The consequence of discongrency of the hip joint may be early, secondary osteoarthritis of the hip joint, that leads to important limits in movement abilities of an individual. The deficit of the femoral head coverage can be rather easily corrected, but only until the growth and maturation of the pelvis is completed. Redirection of the acetabular fragment can be performed by use of the periacetabular osteotomy according to Ganz. This type of the osteotomy is mainly used in the treatment of the acetabular displasia in patients with closed Y cartilage, but also in the treatment of the osteoarthritis of the hip joint. The Aim of the study was to present our early results of treatment of the patients with the secondary osteoarthritis of the hip joint by use of the periacetabular osteotomy according to Ganz.

Material and Methods. Our material consisted of 64 patients, 72 hip joints, operated on between 1998–2004. 20 patients (24 hip joints) were selected from this group. In these 20 patients the indication for the treatment was not only the acetabular displasia, but also osteoarthritis of the hip joint. Our group consisted of 17 female and 3 male. In 4 cases the both hip joints were affected. The age of the patients was 26–44 years, average 34 years. The observation period was from 4 months to 6 years, average 2,5 years. The most important clinical symptom was the groin pain on the rest or while flexing the hip joint with internal rotation and adduction. The radiological symptoms in patients before the operation were: decentration, narrowing of the articular space, cysts beyond the sclerotic zone, fatigue fractures of the acetabular edge.

Results. In all the patients, except of one, the pain disappeared. Abduction and internal rotation in the hip joint increased, but flexion decreased. The Wiberg’s angle increased from 10–15° to 25–40°, and the interior Wiberg’s angle from 10–0° to 15–20°. During follow up we observed remodeling of the cysts. The treatment was subjectively assessed by the patients as very good.

Conclusion. The use of the periacetabular osteotomy occording to Ganz is the operation that corrects the hip joint. But in some cases of the osteoarthritis of the hip joint it allows to improve the quality of life and we hope may also delay the arthroplasty in the young age.