PERIACETABULAR ROTATIONAL OSTEOTOMY WITH CONCOMITANT HIP ARTHROSCOPY FOR THE TREATMENT IN PATIENTS WITH HIP DYSPLASIA

Abstract

Introduction: Periacetabular rotational osteotomy is a joint preserving reconstructive surgery indicated in hip dysplasia. However hip dysplasia is frequently accompanied by intraarticular pathology like labral tears. This study was undertaken to ascertain whether:

1. concomitant hip arthroscopy during osteotomy could identify intra-articular pathology associated with hip dysplasia;

2. hip arthroscopy combined with our technique of acetabular osteotomy was effective in treatment of intraarticular pathology;

3. this technique was associated with a favorable outcome over a mid term followup period.

Materials: Between July 2001 and February 2005, 43 dysplastic hips with 40 patients consecutive of periac-etabular rotational osteotomy using modified Ollier’s approach and concomitant hip arthroscopy could be followed up at average 52 months (range, 42–67 months). On arthroscopic examination labral lesion and cartilage condition was evaluated and torn labrum was treated. Two patients underwent simultaneous femoral procedures. Mean age at the time of surgery was 40 years (range, 20–67 years). Pre and postoperative hip function was compared using Harris hip score. Radiographic evaluation consisted of pre and postoperative measurement of CE angle, Sharp angle, acetabular head index, head lateralization index and medialization of femoral head. The degree of osteoarthritis was evaluated and compared by radiographic appearance using Tönnis classification.

Results: Intraoperative arthroscopic examination revealed labral lesion in 38 hips. Twenty-eight (65%) out of 43 cases showed cartilage degeneration on arthros-copy. Mean HHS changed from 72.4 preoperatively to 94 postoperatively. On radiographic evaluation CE angle changed from 6.3o to 32.3o, Sharp angle changed from 47o to 39o, acetabular head index changed from 57% to 92% thus indicating the increase in contact area. Head lateralization index changed from 61.2 to 54.9. At the latest review, the severity of osteoarthritis improved in 12 (28%), remained unchanged in 29 (67.4%), and worsened in 2 cases (4.7%). Complications include intraarticular osteotomy, disruption of posterior column and deep vein thrombosis in 1 case each. No other complications like non-union, nerve injury, avascular necrosis, or infection were seen. No patients underwent a conversion THA indicating a 100% survival for the minimum followup period of 42 months and beyond.

Conclusion: Periacetabular rotational osteotomy showed good results in midterm and in 88% of cases we observed and treated labral lesion through a concomitant hip arthroscopy. Thus we recommend that evaluation and treatment of labral lesion should be considered when the joint-preserving acetabular osteotomy is performing due to dysplastic hip.