San Diego Pelvic Osteotomy in Patients with Closed Triradiate Cartilage

Overview

Journal J Child Orthop

Publisher Sage Publications

Specialty Pediatrics

Date 2018 Oct 9

PMID 30294370

Authors

J Murar

L S Dias

V T Swaroop

Affiliations

Soon will be listed here.

Abstract

Purpose: A San Diego pelvic osteotomy is frequently used as part of the surgical treatment of neuromuscular patients with hip displacement. This short-term follow-up study assesses the effectiveness of this osteotomy in patients with closed triradiate cartilage compared with open triradiates.

Methods: Retrospective review of 43 patients (44 hips) with neuromuscular hip disease who underwent a San Diego pelvic osteotomy to correct hip displacement. In all 24 hips had open triradiate cartilage at the time of surgery and 20 hips were closed. Centre edge angle (CEA), acetabular angle (AA) and Reimer's index (RI) were recorded from preoperative, postoperative and the latest follow-up radiographs and statistical analysis was performed.

Results: CEA improved by 39° (7° to 69°) in the open group and 30° (9° to 80°) in the closed group from preoperative radiographs to postoperative, with no significant difference in improvement between groups (p = 0.084). There was no significant difference in AA between the open (improved by 11° (3° to 23°)) and closed (improved by 10° (4° to 21°)) groups (p = 0.65). RI improved from 61% to 11% in the open group and 51% to 12% in the closed group. There was no statistically significant difference between groups in RI at preoperative, immediate postoperative and final follow-up radiographs. At latest follow-up, CEA, AA and RI all remained relatively stable in both groups.

Conclusions: San Diego pelvic osteotomy is equally effective in improving radiographic parameters in neuromuscular patients with both open and closed triradiate cartilage. This study challenges the notion that closed triradiate cartilage is a contraindication to a San Diego pelvic osteotomy.

Level Of Evidence: III.

References

DEGA W . [Transiliac osteotomy in the treatment of congenital hip dysplasia]. Chir Narzadow Ruchu Ortop Pol. 1974; 39(5):601-13. View

Roposch A, Wedge J . An incomplete periacetabular osteotomy for treatment of neuromuscular hip dysplasia. Clin Orthop Relat Res. 2005; (431):166-75. DOI: 10.1097/01.blo.0000149819.70975.4e. View

SMITH-PETERSEN M . Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949; 31A(1):40-6. View

Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney K . Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop. 1998; 17(5):592-602. DOI: 10.1097/00004694-199709000-00005. View

Cooperman D, Bartucci E, Dietrick E, Millar E . Hip dislocation in spastic cerebral palsy: long-term consequences. J Pediatr Orthop. 1987; 7(3):268-76. DOI: 10.1097/01241398-198705000-00005. View

Hoffer M, Stein G, Koffman M, Prietto M . Femoral varus-derotation osteotomy in spastic cerebral palsy. J Bone Joint Surg Am. 1985; 67(8):1229-35. View

McNerney N, Mubarak S, Wenger D . One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop. 2000; 20(1):93-103. View

Inan M, Gabos P, Domzalski M, Miller F, Dabney K . Incomplete transiliac osteotomy in skeletally mature adolescents with cerebral palsy. Clin Orthop Relat Res. 2007; 462:169-74. DOI: 10.1097/BLO.0b013e318124fdca. View

Mubarak S, Valencia F, Wenger D . One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage. J Bone Joint Surg Am. 1992; 74(9):1347-57. View

10.

Moreau M, Drummond D, Rogala E, Ashworth A, Porter T . Natural history of the dislocated hip in spastic cerebral palsy. Dev Med Child Neurol. 1979; 21(6):749-53. DOI: 10.1111/j.1469-8749.1979.tb01696.x. View

11.

MacDonald S, Hersche O, Ganz R . Periacetabular osteotomy in the treatment of neurogenic acetabular dysplasia. J Bone Joint Surg Br. 2000; 81(6):975-8. DOI: 10.1302/0301-620x.81b6.9700. View

12.

Brunner R, Baumann J . Clinical benefit of reconstruction of dislocated or subluxated hip joints in patients with spastic cerebral palsy. J Pediatr Orthop. 1994; 14(3):290-4. DOI: 10.1097/01241398-199405000-00003. View

13.

Robb J, Brunner R . A Dega-type osteotomy after closure of the triradiate cartilage in non-walking patients with severe cerebral palsy. J Bone Joint Surg Br. 2006; 88(7):933-7. DOI: 10.1302/0301-620X.88B7.17506. View

14.

ROOT L, Laplaza F, Brourman S, Angel D . The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening. J Bone Joint Surg Am. 1995; 77(5):703-12. DOI: 10.2106/00004623-199505000-00006. View

15.

PEMBERTON P . PERICAPSULAR OSTEOTOMY OF THE ILIUM FOR TREATMENT OF CONGENITAL SUBLUXATION AND DISLOCATION OF THE HIP. J Bone Joint Surg Am. 1965; 47:65-86. View

16.

Lee Y, Chung C, Koo K, Lee K, Kwon D, Park M . Measuring acetabular dysplasia in plain radiographs. Arch Orthop Trauma Surg. 2011; 131(9):1219-26. DOI: 10.1007/s00402-011-1279-4. View

17.

Jozwiak M, Marciniak W, Piontek T, Pietrzak S . Dega's transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy. J Pediatr Orthop B. 2001; 9(4):257-64. DOI: 10.1097/01202412-200010000-00009. View

18.

Bagg M, Farber J, Miller F . Long-term follow-up of hip subluxation in cerebral palsy patients. J Pediatr Orthop. 1993; 13(1):32-6. DOI: 10.1097/01241398-199301000-00007. View

19.

Samaniego E, Sheth R . Bone consequences of epilepsy and antiepileptic medications. Semin Pediatr Neurol. 2007; 14(4):196-200. DOI: 10.1016/j.spen.2007.08.006. View