TITLE

Analysis of Osteonecrosis Following Pemberton Acetabuloplasty in Developmental Dysplasia of the Hip

AUTHOR(S)
Kuan-Wen Wu; Ting-Ming Wang; Shier-Chieg Huang; Kuo, Ken N.; Chi-Wen Chen
PUB. DATE
September 2010
SOURCE
Journal of Bone & Joint Surgery, American Volume;Sep2010, Vol. 92-A Issue 11, p2083
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The favorable results of Pemberton acetabuloplasty in children with developmental dysplasia of the hip have been well reported. We reviewed our long-term results related to osteonecrosis of the femoral head after this surgery, especially with regard to the effect of excessive inferior displacement of the femoral head. Methods: From 1993 to 1997, we performed 167 Pemberton acetabuloplasties in patients with developmental dysplasia of the hip who were eighteen months of age or older. Patients who had had prior treatment or developmental dysplasia of the hip due to neuromuscular disease were excluded. We selected patients who had unilateral developmental dysplasia of the hip, had undergone simultaneous open reduction and Pemberton acetabuloplasty between the ages of eighteen and thirty-six months, and had been followed for a minimum often years. Forty-nine patients met these criteria. The patients were divided into osteonecrosis-absent and osteonecrosis-present groups according to the criteria described by Kalamchi and MacEwen. Preoperative, interim follow-up and final radiographs were available for evaluation, as were the results of clinical examination. We used the femoral head inferior displacement percentage, measured on the radiographs, to quantify the amount of excessive correction postoperatively. Outcomes were measured with use of the McKay criteria and the Severin criteria. Results: The mean age at the time of surgery was 20.8 months, and the mean duration of follow-up was 134.6 months. Twenty-four patients (49%) were classified as not having osteonecrosis (the osteonecrosis-absent group) and twenty-five patients (51%), as having osteonecrosis (the osteonecrosis-present group). There were no significant differences between the two groups in terms of sex, age, laterality, Tönnis grade, or preoperative acetabular index. Seven of the cases of osteonecrosis were type I, thirteen were type II, one was type III, and four were type IV. The inferior displacement percentage revealed significant differences between the two groups (p < 0.0001). In the osteonecrosis-absent group, 96% of the patients had a radiographically satisfactory result (Severin class I or II); however, only 76% of the patients in the osteonecrosis-present group had a radiographically satisfactory result (p < 0.0001). According to the McKay criteria, there were significant clinical differences between the groups (p < 0.0001). Conclusions: Our results showed significant correlation between excessive reduction of the femoral head and the development of osteonecrosis. In light of the high prevalence of type-II osteonecrosis, we postulated that the lateral epiphyseal branch of the medial circumflex artery was vulnerable to compression with increased inferior displacement of the femoral head. The latest radiographic and functional results corresponded to the severity of the osteonecrosis. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
53896795

 

Related Articles

  • Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling. Roposch, Andreas; Ridout, Deborah; Protopapa, Evangelia; Nicolaou, Nicholas; Gelfer, Yael // Clinical Orthopaedics & Related Research;Jul2013, Vol. 471 Issue 7, p2318 

    Background: Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear. Questions/purposes: Using four measures of acetabular development, we (1) determined whether acetabular...

  • THE PREVALENCE OF ACETABULAR RETROVERSION AMONG VARIOUS DISORDERS OF THE HIP. Ezoe, Masamitsu; Naito, Masatoshi; Inoue, Toshio // Journal of Bone & Joint Surgery, American Volume;Feb2006, Vol. 88-A Issue 2, p372 

    Background: Acetabular retroversion can result from posterior wall deficiency in an otherwise normally oriented acetabulum or from excessive anterior coverage secondary to a malpositioned acetabulum, or both. Theoretically, a retroverted acetabulum, which adversely affects load transmission...

  • Does Salter Innominate Osteotomy Predispose the Patient to Acetabular Retroversion in Adulthood? Kobayashi, Daisuke; Satsuma, Shinichi; Kinugasa, Maki; Kuroda, Ryosuke; Kurosaka, Masahiro // Clinical Orthopaedics & Related Research;May2015, Vol. 473 Issue 5, p1755 

    Background: Salter innominate osteotomy has been identified as an effective additional surgery for the dysplastic hip. However, because in this procedure, the distal segment of the pelvis is displaced laterally and anteriorly, it may predispose the patient to acetabular retroversion. The degree...

  • Coxa Profunda: Is the Deep Acetabulum Overcovered? Anderson, Lucas; Kapron, Ashley; Aoki, Stephen; Peters, Christopher // Clinical Orthopaedics & Related Research;Dec2012, Vol. 470 Issue 12, p3375 

    Background: Coxa profunda, or a deep acetabular socket, is often used to diagnose pincer femoroacetabular impingement (FAI). Radiographically, coxa profunda is the finding of an acetabular fossa medial to the ilioischial line. However, the relative position of the acetabular fossa to the pelvis...

  • A new tilt on pelvic radiographs: a pilot study. P. Richards; J. Pattison; J. Belcher; R. DeCann; Suzanne Anderson; C. Wynn-Jones // Skeletal Radiology;Feb2009, Vol. 38 Issue 2, p113 

    Abstract Aim  The aim of this study was to evaluate pelvic tilt on commonly performed measurements on radiography in primary protrusio acetabuli and developmental dysplasia of the hip. Materials and methods  A dry assembled pelvis and spine skeleton was...

  • Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. Torres Claramunt, Raúl; Marqués, Fernando; León, Alfonso; Vilà, Gemma; Mestre, Carlos; Puig Verdié, Lluís // International Orthopaedics;Dec2011, Vol. 35 Issue 12, p1767 

    Purpose: The purpose of this study was to review retrospectively the cases operated upon in our department in recent years with a Wagner stem and a small socket in cases of Crowe I or II dysplastic hips. Methods: We conducted a retrospective clinical radiological review of 30 hips diagnosed with...

  • Repair in osteonecrosis of the femoral head: MR imaging features at long-term follow-up. Takao, Masaki; Nishii, Takashi; Sakai, Takashi; Yoshikawa, Hideki; Sugano, Nobuhiko // Clinical Rheumatology;Aug2010, Vol. 29 Issue 8, p841 

    The purpose of this study was to evaluate retrospectively the progression of reparative changes in osteonecrosis of the femoral head over a long period of time, using both serial plain films and magnetic resonance (MR) images. The subjects were 25 patients with 33 hips affected by osteonecrosis,...

  • Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip. Roposch, Andreas; Liu, Liang Q.; Offiah, Amaka C.; Wedge, John H. // Journal of Bone & Joint Surgery, American Volume;12/21/2011, Vol. 93-A Issue 24, p2263 

    Background: Osteonecrosis of the femoral head is a major potential complication following the treatment of develop mental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant. Methods: In the present cross-sectional study, we...

  • The Bernese Periacetabular Osteotomy: A Review of Surgical Technique. Olson, Steven A. // Duke Orthopaedic Journal;Jul2010-Jun2011, Vol. 1 Issue 1, p21 

    The Bernese periacetabular osteotomy (PAO) is a powerful technique in the treatment of hip dysplasia and related conditions of the hip. This technique is performed through a single anterior surgical approach. There are three steps in learning to perform the PAO. These include: mastering the...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics