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Techniques and Results for Open Hip Preservation.

Levy DM, Hellman MD, Haughom B, Stover MD, Nho SJ - Front Surg (2015)

Bottom Line: Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy.Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum.Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA.

ABSTRACT
While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum. Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

No MeSH data available.


Related in: MedlinePlus

A postoperative radiograph of a periacetabular osteotomy secured with screws.
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Figure 2: A postoperative radiograph of a periacetabular osteotomy secured with screws.

Mentions: Numerous pelvic osteotomies have been designed to treat hip dysplasia. The primary goal of an osteotomy for dysplasia is to correct the deficiency in acetabular coverage. Reshaping osteotomies include the Pemberton and Dega techniques, which utilize incomplete cuts of the ilium to hinge off the triradiate cartilage. These osteotomies are reserved for skeletally immature individuals (22). Reconstructive osteotomies may be performed in patients with closed physes and utilize complete cuts of the pelvis in order to redirect joint loading forces. LeCouer first described the triple osteotomy in 1965 (22). This osteotomy requires two incisions to make individual cuts through the pubis, ischium, and ilium. The more commonly used technique today in adolescent and adult patients is the Bernese periacetabular osteotomy (PAO) (25). First described by Ganz, this procedure may be done through a single Smith-Peterson approach. It reorients the joint through four to five cuts done closer to the acetabulum than in the traditional triple osteotomy. These cuts maintain stability within the pelvis by not disrupting the posterior column. The osteotomy site is typically secured with screws (see Figure 2). Patients remain partial weight bearing with crutches for 6 weeks postoperatively (26).


Techniques and Results for Open Hip Preservation.

Levy DM, Hellman MD, Haughom B, Stover MD, Nho SJ - Front Surg (2015)

A postoperative radiograph of a periacetabular osteotomy secured with screws.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664697&req=5

Figure 2: A postoperative radiograph of a periacetabular osteotomy secured with screws.
Mentions: Numerous pelvic osteotomies have been designed to treat hip dysplasia. The primary goal of an osteotomy for dysplasia is to correct the deficiency in acetabular coverage. Reshaping osteotomies include the Pemberton and Dega techniques, which utilize incomplete cuts of the ilium to hinge off the triradiate cartilage. These osteotomies are reserved for skeletally immature individuals (22). Reconstructive osteotomies may be performed in patients with closed physes and utilize complete cuts of the pelvis in order to redirect joint loading forces. LeCouer first described the triple osteotomy in 1965 (22). This osteotomy requires two incisions to make individual cuts through the pubis, ischium, and ilium. The more commonly used technique today in adolescent and adult patients is the Bernese periacetabular osteotomy (PAO) (25). First described by Ganz, this procedure may be done through a single Smith-Peterson approach. It reorients the joint through four to five cuts done closer to the acetabulum than in the traditional triple osteotomy. These cuts maintain stability within the pelvis by not disrupting the posterior column. The osteotomy site is typically secured with screws (see Figure 2). Patients remain partial weight bearing with crutches for 6 weeks postoperatively (26).

Bottom Line: Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy.Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum.Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA.

ABSTRACT
While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum. Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

No MeSH data available.


Related in: MedlinePlus