The choice of pelvic osteotomy technique in young children with hip dysplasia

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Abstract

BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy.

AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique.

MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 2–4 years (3.1 ± 0.45) with grade II–IV hip dysplasia, according to the supplemented classification of Tönnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neck–shaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO).

RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation.

CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p > 0.05), and reduction of possible secondary deformities.

About the authors

Pavel I. Bortulev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN-code: 9903-6861
Scopus Author ID: 57193258940

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Tamila V. Baskaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
SPIN-code: 5487-4230

MD, Orthopedic and Trauma Surgeon

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930
Scopus Author ID: 6504128319
ResearcherId: P-8596-2015

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg; Saint Petersburg

Dmitry B. Barsukov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN-code: 2454-6548

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Ivan Yu. Pozdnikin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN-code: 3744-8613

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Makhmud S. Poznovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: poznovich@bk.ru
ORCID iD: 0000-0003-2534-9252
SPIN-code: 1357-0260

MD, Research Associate

Russian Federation, Saint Petersburg

Vladimir E. Baskov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dr.baskov@mail.ru
ORCID iD: 0000-0003-0647-412X
SPIN-code: 1071-4570

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Pavel N. Kornyakov

Federal Center for Traumatology, Orthopedics and Arthroplasty

Author for correspondence.
Email: pashat-1000@mail.ru
ORCID iD: 0000-0002-7124-5473

MD, Orthopedic and Trauma Surgeon

Russian Federation, Cheboksary

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Supplementary files

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2. Fig. 1. Tönnis supplemented the classification of the severity of hip dysplasia. AI, acetabular index

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3. Fig. 2. Proposed differentiated approach to the choice of pelvic osteotomy depending on the type of the acetabular deformity (Tönnis supplemented classification) and the corrective possibilities of surgical technologies. AI, acetabular index [25]

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4. Fig. 3. Radiograph of patient Z., 3 years old, with Tönnis grade III dysplasia of the right hip joint: a, before surgery; b, after radical reconstruction with a modified Salter surgery using an autograft from the femur (indicated by an arrow)

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Copyright (c) 2023 Bortulev P.I., Baskaeva T.V., Vissarionov S.V., Barsukov D.B., Pozdnikin I.Y., Poznovich M.S., Baskov V.E., Kornyakov P.N.

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