Incomplete periacetabular acetabuloplasty

Abstract

BackgroundResidual acetabular dysplasia is one of the most common complications after treatment for developmental dysplasia of the hip. The acetabular growth response after reduction of a dislocated hip varies. The options are to wait and add a redirectional osteotomy as a secondary procedure at an older age, or to perform a primary acetabuloplasty at the time of the open reduction to stimulate acetabular development. We present the early results of such a procedure—open reduction and an incomplete periacetabular acetabuloplasty—as a one-stop procedure for developmental dysplasia of the hip.Patients and methodsWe retrospectively reviewed the results obtained with 55 hips (in 48 patients, 43 of them girls) treated between September 2004 and February 2011. This cohort included late presentations and failures of nonoperative treatment and excluded unsuccessful previous surgical treatment (including closed reductions), neuromuscular disease, and other teratological conditions. Patients were treated once the ossific nucleus was present or when they reached one year of age. 31 cases were late presentations while 17 represented failures of nonoperative treatment. The mean age of the patients at surgery was 1.3 (0.6–2.6) years. The mean follow-up period was 4 (2–8) years. According to the IHDI classification, 1 was grade I, 9 were grade II, 13 were grade III, and 32 were grade IV.ResultsThe mean acetabular index fell from 38 (23–49) preoperatively to 21 (10–27) at the last follow-up. There were no infections, nerve palsies, or graft extrusions. None of the cases required secondary surgery for residual acetabular dysplasia. 8 patients developed avascular necrosis (AVN) of grade II or more. The incidence of AVN was significantly associated with previous, failed nonoperative treatment. 1 patient developed coxa magna requiring shelf arthroplasty 4 years after the index procedure and 1 patient with lateral growth arrest required medial screw epiphysiodesis.InterpretationThis incomplete periacetabular acetabuloplasty is a reliable adjunct to open reductions, and it is followed by a rapid acetabular growth response that avoids secondary pelvic procedures. It is a one-stop surgery with predictable outcome that can be performed in 0.5- to 2.5-year-old children.

Acetabuloplasties at Open Reduction Prevent Acetabular Dysplasia in Intentionally Delayed Developmental Dysplasia of the Hip: A Case-control Study

“…In the United Kingdom, a randomized controlled trial was launched in 2014 to compare the AVN rate in children with dislocated hips treated early with those treated with intentionally delayed surgery. Nevertheless, these represent higher proportions of patients with avascular necrosis than previous series by the same surgeon [4,7,8]. However, our rate of AVN is similar to other case-control studies; Segal et al [36] reported a 32% rate and Sankar et al [33] 41%.…”

“…The purpose of this case-control study was to determine whether an incomplete periacetabular acetabuloplasty as an added step to delayed open reductions would diminish the risk of developing acetabular dysplasia or increase the risk of AVN. This added step has proven to add minimal morbidity or surgical time [7].…”

“…Because AVN and residual acetabular dysplasia are the two main complications of DDH treatment, the ideal treatment would minimize one without increasing the incidence of the other. Early in 2014 [7], we published the early results of an incomplete periacetabular acetabuloplasty as an adjunct to delayed open reductions. This added step incurred little morbidity or extra surgical time.…”

“…The debate about the timing of a pelvic procedure to address this common problem is still controversial. For some [7,15,[30][31][32], this can be added primarily at the time of DDH treatment. Others prefer to reserve pelvic procedures for those who develop this complication as a secondary procedure [16,22].…”

“…The case group had an incomplete periacetabular acetabuloplasty as an added step. The full technique has been described elsewhere [7]. Briefly, after capsulorrhaphy, the outer table of the ilium is osteotomized following the contour of the acetabulum (Fig.…”