Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities
Background Residual acetabular dysplasia of the hip in most patients can be corrected by periacetabular osteot-omy.However,some patients have intraarticular abnormalities causing insufficient coverage,containment or congruency after periacetabular osteotomy,or extraar-ticular abnormalities that limit either acetabular correction or hip motion.For these patients,we believe an additional proximal femoral osteotomy can improve coverage,con-tainment,congruency and/or motion.Purposes We provide algorithms for(1)identifying patients we believe will benefit from proximal femoral osteotomy,(2)selecting the appropriate osteotomy,and(3)choosing the sequence of these osteotomies.Methods Anteroposterior,false-profile and functional radiographs and MR can identify most patients we believe will benefit from periacetabular and femoral osteotomies.Recently described techniques,including relative femoral neck lengthening,femoral neck osteotomy and femoral head osteotomy have expanded indications for a combined procedure.Historically performed first,periacetabular osteotomy is now frequently performed following femoral osteotomy.Results The rate of intertrochanteric osteotomy per-formed with periacetabular osteotomy has decreased from approximately 10%in the first 500 surgeries to about 2%currently.Among 151 relative neck lengthenings(23 with PAO),53 femoral neck osteotomies(4 with PAO)and 14 femoral head osteotomies(11 with PAO),eleven compli-cations occurred including osteonecrosis in two and delayed unions in eight.No complication occurred fol-lowing a combined procedure.Conclusion Although isolated periacetabular osteotomy can provide sufficient coverage,containment and congru-ency for most patients with residual hip dysplasia,some may benefit from an additional proximal femoral osteot-omy.Knowing the appropriate indications,selection,and sequencing of these osteotomies is critical for enhancing patient outcomes.
Reinhold Ganz Kevin Horowitz Michael Leunig
University of Berne,Berne,Switzerland Department of Orthopedics,Schulthess Clinic,Lengghalde 2,8008 Zurich,Switzerland University of Berne,Berne,Switzerland;Department of Orthopedics,Schulthess Clinic,Lengghalde 2,8008
国内会议
北京
英文
92-104
2018-10-25（万方平台首次上网日期，不代表论文的发表时间）