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Pelvic Osteotomy for Adult Patients with Hip Dysplasia

  • Szu-Yuan Chen
  • Pang-Hsin Hsieh
  • Wen-E Yang
  • Ting-Ming Wang
Chapter

Abstract

For a DDH patient under age of 40 or an older patient without advanced degenerative arthritis, pelvic osteotomies may be a better choice than a hip replacement. Periacetabular osteotomy (PAO) is indicated for a patient with a relatively congruent hip. Hsieh’s periacetabular osteotomy is modified from Ninomiya rotational osteotomy and Ganz Bernese PAO. Trochanter osteotomy provides a better vision to the surgical field and capsulotomy can be done for assessment and debridement for the intra-articular lesions. Round-shaped osteotomy makes rotation of the segment easier and changes the shape of pelvic cavity less than a diagonal osteotomy. Salvage osteotomies with or without a proximal femoral osteotomy are indicated for a patient with an incongruent joint which is not to be restored by a PAO. Chiari osteotomy osteotomizes the pelvis above the acetabulum, medializes the distal fragment, and uses the joint capsule for interposition between the head and the proximal fragment for a better coverage. Shelf acetabuloplasty creates a slot at the pelvis above the femoral head and uses a bone graft to cover the femoral head. Chiari osteotomy has the advantage of a better coverage of the femoral head and better abduction of the hip, while shelf acetabuloplasty is easier to perform and may have fewer complications.

Keywords

Developmental dysplasia of the hip Periacetabular osteotomy (PAO) Hsieh’s modification of PAO Chiari osteotomy Shelf acetabuloplasty 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Szu-Yuan Chen
    • 1
  • Pang-Hsin Hsieh
    • 2
  • Wen-E Yang
    • 3
  • Ting-Ming Wang
    • 4
  1. 1.Bone and Joint Research CenterLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
  2. 2.Department of Orthopaedic SurgeryLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
  3. 3.Department of Orthopaedic Surgery, Joint ReconstructionLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
  4. 4.Department of Orthopaedic SurgeryNational Taiwan University Medical CenterTaipeiTaiwan

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