FOR THE TREATMENT OF PERTHES-LIKE HIP DEFORMITIES: A REPORT OF ... of Perthes' disease, present difficult management dilemmas. We present our ...
COMBINED PERIACETABULAR OSTEOTOMY AND SURGICAL DISLOCATION FOR THE TREATMENT OF PERTHES-LIKE HIP DEFORMITIES: A REPORT OF SEVEN CASES W Dandachli, Z Beech, MJK Bankes Guy’s & St Thomas’ Hospital, London, UK
Abstract
Introduction Periacetabular osteotomy is an established surgical treatment for adult patients with symptomatic residual developmental dysplasia of the hip. Patients with proximal femoral deformities associated with a dysplastic acetabulum, such as those seen as a consequence of Perthes’ disease, present difficult management dilemmas. We present our early experience with performing a periacetabular osteotomy (PAO) combined with surgical hip dislocation, femoral head-neck osteochondroplasty and trochanteric advancement in seven patients presenting with adult consequences of Perthes’ disease.
Materials and Methods We have consecutively performed a combined PAO and surgical hip dislocation on seven hips in six patients presenting with hip pain and restricted range of motion and background history of Perthes’ disease in childhood. They had a combination of severe femoral head deformity and dysplastic acetabulum. Their mean age was 23 years (range 2040) and mean BMI was 26 (range 20-35). There were 4 females and 3 males. The PAO was performed through a trans-sartorial approach (Soballe et al) with the osteotomy done in line with the Bernese method (Ganz et al). The posterolateral approach with greater trochanteric osteotomy was used for the surgical dislocation (Ganz et a). Pre- and post-operative hip scores were collected and the lateral centre-edge angle (LCEA) and the acetabular index angle (AIA) were measured.
Results The mean follow-up was 16 months (range 6-28 months). The patients’ mean Harris Hip Score improved from 60 to 72, Oxford Hip Score from 36 to 50, WOMAC score from 42 to 20, NAHS from 50 to 70. The mean length of stay was 6 days (range 4-7 days). Two patients had enough blood in the cell-saver to have a reinfusion (125 and 328 mls). There was an improvement in the mean LCEA from 8° to 23° and in the mean AIA from 22° to 6°. There were two superficial wound infections treated successfully with a short course of antibiotics.
Discussion Combined PAO and surgical dislocation with trochanteric advancement provides a logical surgical solution for symptomatic patients with acetabular dysplasia associated with femoral head deformity. Our early experience with the procedure suggests it is a safe and effective at improving patients’ symptoms. Further work is needed to show its long-term efficacy on a larger scale. Keywords
