Pelvic Support Osteotomy

Abstract

Prior to the development of effective total hip arthroplasty, “pelvic support” osteotomies were described as salvage reconstructive procedures for osteoarthritic hips to reduce pain and Trendelenburg limp while preserving hip motion. In addition to modest efficacy at best, iatrogenic shortening and valgus deformity significantly restricted the role of these osteotomies in clinical practice, even before the introduction of total hip arthroplasty. Ilizarov introduced important secondary reconstructive deformity correction and lengthening strategies, using his gradual correction and adaptable circular fixator to improve clinical results over the original procedures. Occasional patients with relatively mobile hips and minimal pain but poor hip function due to septic destruction, irreducible dislocation, or neurogenic functional impairment who are not reasonable candidates for total hip arthroplasty may benefit from pelvic support osteotomy with Ilizarov’s methods of external fixation, gradual deformity correction, and distal reconstruction. We describe here a patient with fixed, neurogenic hip dislocations and symptomatic Trendelenburg gait associated with trisomy 21 (Down syndrome) treated effectively by pelvic support osteotomy and distal deformity reconstruction.