Abstract
Background
Pericapsular acetabuloplasty procedures have been widely used as an integral component of combined surgery to treat developmental hip dislocation after walking age. The stability of the acetabuloplasty and the maintenance of the acetabular correction will depend on the structural integrity of the iliac crest autograft, which, traditionally, has been inserted as the interposition material. Problems related to the use of an autograft have been encountered by various surgeons—including the authors—namely, graft displacement and resorption, which may necessitate internal fixation or result in revision surgery. To overcome autograft failure, the use of an allograft as the interposition material has been introduced by some surgeons. This study describes the radiologic results of 147 hips treated for developmental hip dislocation by means of a standard protocol of open hip reduction and pericapsular acetabuloplasty with a contoured iliac crest allograft as the interposition material.
Methods
This retrospective study reviewed the radiographs of 147 hips presenting with late developmental dislocation which were treated by open reduction and a concomitant pericapsular acetabuloplasty using a contoured iliac crest allograft as the interposition material. The minimum follow up period was 2 years. Measurement of the acetabular index (AI) was the main variable. The efficacy of the interposed iliac crest allograft as the main stabiliser of the acetabuloplasty was reflected by the maintenance of the corrected AI during the follow up period. Loss of acetabular correction, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection, hip redislocation and avascular necrosis (AVN) as possible complications were documented.
Results
The treatment protocol of a combined open reduction of the hip and pericapsular acetabuloplasty, inserting a contoured iliac crest allograft as the interposition material, resulted in concentrically reduced and stable hips in 96.6% of our cases. The redislocation rate was 3.4%. All of the allografts were completely incorporated at 6 months post-surgery with no graft-related infections. In only two hips was the acetabular correction not maintained. None of the osteotomies required internal fixation for stability, even in older children.
Conclusion
We believe that a contoured iliac crest allograft as the pericapsular acetabuloplasty interposition material renders excellent osteotomy stability that eliminates the need for internal fixation and—in the short-term—maintains the correction of the acetabulum achieved intra-operatively.
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References
Mitchell PD, Redfern RC (2007) The prevalence of dislocation in developmental dysplasia of the hip in Britain over the past thousand years. J Pediatr Orthop 27(8):890–892
Mirdad T (2002) Incidence and pattern of congenital dislocation of the hip in Aseer region of Saudi Arabia. West Afr J Med 21(3):218–222
Vedantam R, Capelli AM, Schoenecker PL (1998) Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children. J Pediatr Orthop 18(2):254–258
Wada A, Fujii T, Takamura K, Yanagida H, Taketa M, Nakamura T (2003) Pemberton osteotomy for developmental dysplasia of the hip in older children. J Pediatr Orthop 23(4):508–513
Pemberton PA (1965) Pericapsular osteotomy of the Ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 47:65–86
Szepesi K, Rigó J, Bíró B, Fazekas K, Póti L (1996) Pemberton’s pericapsular osteotomy for the treatment of acetabular dysplasia. J Pediatr Orthop B 5(4):252–258
Tonnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer, Berlin Heidelberg New York
Kalamchi A, MacEwen GD (1980) Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 62(6):876–888
Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE (2000) Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 82(1):17–27
Lin CJ, Lin YT, Lai KA (2000) Intraoperative instability for developmental dysplasia of the hip in children 12 to 18 months of age as a guide to Salter osteotomy. J Pediatr Orthop 20(5):575–578
Haidar RK, Jones RS, Vergroesen DA, Evans GA (1996) Simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip. J Bone Joint Surg Br 78(3):471–476
Macnicol MF, Bertol P (2005) The Salter innominate osteotomy: should it be combined with concurrent open reduction? J Pediatr Orthop B 14(6):415–421
Ruszkowski K, Pucher A (2005) Simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip in children under 24 months of age. J Pediatr Orthop 25(5):695–701
Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL (2004) Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures. J Bone Joint Surg Br 86(6):876–886
Lindstrom JR, Ponseti IV, Wenger DR (1979) Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am 61(1):112–118
Salter RB (1961) Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg Br 43(3)518–539
Perlik PC, Westin GW, Marafioti RL (1985) A combination pelvic osteotomy for acetabular dysplasia in children. J Bone Joint Surg Am 67(6):842–850
Tavares JO (2004) Modified Pemberton acetabuloplasty for the treatment of congenital hip dysplasia. J Pediatr Orthop 24(5):501–507
Dega W (1969) Selection of surgical methods in the treatment of congenital dislocation of the hip in children. Chir Narzadow Ruchu Ortop Pol 34:357–366
Grudziak JS, Ward WT (2001) Dega osteotomy for the treatment of congenital dysplasia of the hip. J Bone Joint Surg Am 83(6):845–854
Mubarak SJ, Valencia FG, Wenger DR (1992) One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage. J Bone Joint Surg Am 74(9):1347–1357
Slomczykowski M, Mackenzie WG, Stern G, Keeler KA, Glutting J (1998) Acetabular volume. J Pediatr Orthop 18(5)657–661
Chung CY, Choi IH, Cho TJ, Yoo WJ, Lee SH, Park MS (2008) Morphometric changes in the acetabulum after Dega osteotomy in patients with cerebral palsy. J Bone Joint Surg Br 90(1):88–91
Ozgur AF, Aksoy MC, Kandemir U, Karcaaltncaba M, Aydingoz U, Yazici M, Surat A (2006) Does Dega osteotomy increase acetabular volume in developmental dysplasia of the hip? J Pediatr Orthop B 15(2):83–86
Mankin HJ, Doppelt S, Tomford W (1983) Clinical experience with allograft implantation. The first ten years. Clinic Orthop Relat Res 174:69–86
Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996) Long-term results of allograft replacement in the management of bone tumors. Cinic Orthop Relat Res 324:86–97
Tavares JO, Molinero K (2006) Elevation of medial tibial condyle for severe tibia vara. J Pediatr Orthop B 15(5):362–369
Kessler JI, Stevens PM, Smith JT, Carroll KL (2001) Use of allografts in Pemberton osteotomies. J Pediatr Orthop 21(4):468–473
Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77(11):1742–1754
Pirpiris M, Payman KR, Otsuka NY (2006) The assessment of acetabular index: is there still a place for plain radiography? J Pediatr Orthop 26(3):310–315
Kay RM, Watts HG, Dorey FJ (1997) Variability in the assessment of acetabular index. J Pediatr Orthop 17(2):170–173
Berkeley ME, Dickson JH, Cain TE, Donovan MM (1984) Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am 66(3):412–420
Brougham DI, Broughton NS, Cole WG, Menelaus MB (1990) Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. J Bone Joint Surg Br 72(4):557–562
Thomas IH, Dunin AJ, Cole WG, Menelaus MB (1989) Avascular necrosis after open reduction for congenital dislocation of the hip: analysis of causative factors and natural history. J Pediat Orthop 9(5):525–531
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Wade, W.J., Alhussainan, T.S., Al Zayed, Z. et al. Contoured iliac crest allograft interposition for pericapsular acetabuloplasty in developmental dislocation of the hip: technique and short-term results. J Child Orthop 4, 429–438 (2010). https://doi.org/10.1007/s11832-010-0282-6
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DOI: https://doi.org/10.1007/s11832-010-0282-6