Hip Osteotomy

Hip Osteotomy

Overexerts from running or jumping causes mechanical dysfunction; this can be corrected with hip osteotomy.

The progression of early hip arthrosis is directly related to dysplasia in that part of the body, which may progress to early osteoarthritis to causes intense hip pain.

Osteotomy aims to improve the alignment of the joints―it is carried out by an orthopedist or hip specialist.

Types Of Osteotomies: Know The Differences

There are 2 main types of osteotomies, reconstruction, and salvation.

Reconstruction is carried out when there is evidence of remodeling, restricted redirection, wide para-acetabular redirection, spherical and polygonal periacetubals.

Salvation osteotomies are further divided into two groups, sliding ceilings, and interposition.

Where Is Osteotomy Performed?

The procedure is performed in the center, located between the anterosuperior iliac spines.

Osteotomy doesn’t impact the performance of the lower and posterior movements of the acetabulum.

That being said, there is a risk of stiffness due to the plastic deformation produced in the acetabulum.

Salter Osteotomy

Also known as innominate bone osteotomy, it is applied to babies who are above 18 months in age and have an acetabular index of up to 350. The surgery aims to provide an EC angular improvement for 20º–22º.

To obtain the rotation, a fulcrum is performed in the pubic symphysis, and a wedge will be created and filled with a triangular-shaped autograft obtained from the proximal iliac.

A lateral rotation maneuver can help obtain the necessary correction. This will be supported by the extension and adduction of the hip with the knee flexed. It is worth mentioning that the hips should be reduced, and the capsule needs to be closed.

Advantages And Disadvantages In The Results Obtained

Positive results were found in 93.6% of 140 patients aged 18 months to 4 years, with a decrease to 56.7% in those aged 4 to 10 years.

One of the biggest advantages of the procedure includes non-interference in the growth cartilage and suitable acetabular redirection to promote stability.

Disadvantages include limited redirection of 25–30º of extension and 10º of adduction.

Kalamchi Osteotomy

This surgery is performed when the patient has difficulty in extending the limb. It promises improved stability and equalization of the limbs. The disadvantage is that it doesn’t do much to prevent future injuries.

The combination of unnamed bone osteotomy with parasympathetic osteotomy attains the Sutherland and Greenfield osteotomy nomenclature. This is recommended for children older than 8 years since it reduces elasticity in the fulcrum of the pubic symphysis.

It shares benefits with Salter’s osteotomy. The disadvantage is that it increases injury risks in the pudendal vessels, the obturator nerve, and urogenital diaphragm.

In addition to the osteotomy of the unnamed bone, an association with the osteotomy of the pubis and ischium is also found. It is called the triple osteotomy; it generates greater displacement and rotation of the segment that houses the acetabulum. This is recommended for adolescents and adults.

Disadvantages include non-consolidation, lateralization, and contamination due to the proximity of the rectum. It can also cause sciatic nerve injury and a lower degree of rotation.

Hemispheric Osteotomy

This has restricted diffusion due to the reduced margin of error. Because the surgery is linked to the acetabulum, it shouldn’t be opened by the orthopedic doctor.

Type 1 is a simple spherical osteotomy that is considered simple; the condition doesn’t permit medialization or limb elongation.

Type 2 is a combination of the hemispheric osteotomy and the supra-acetabular transverse. This aims to medialize the center of rotation, providing a wide correction.

Its disadvantages include joint penetration and interruption in the vascular supply that goes to the acetabulum.

Ganz Osteotomy

Ganz Osteotomy, also known as Bernese osteotomy, was created to reduce some of the risks that arise in other procedures. This enables the correction of the inclination and acetabular torsion.

Its benefits include high-scale multidirectional correction and preservation of the acetabular blood supply. It also preserves the pelvic ring with minimal internal fixation.

Possible Complications

Complications may arise in the procedure of periacetabular osteotomies; these will be classified into 3 groups by the orthopedic doctor:

• Minor: Treatment is not required due to the lack of consolidation of the public branch and paresthesia in the lateral femoral cutaneous nerve region, and asymptomatic heterotopic ossification.
• Moderate: This group includes the surgical wounds, sciatic neuropraxia, and fractures that do not require re-intervention, with possible minor medical complications.
• Major: The patient is at risk of losing their life when faced with these complications. These complications include long-term nerve damage, hemorrhage, loss of fixation, thrombosis, and severe infection.