Joint-sparing surgery in patients with acetabular dysplasia complicated by sphericity of the femoral head
- Authors: Teplenky M.P.1, Bunov V.S.1, Fozilov J.Т.1
-
Affiliations:
- Ilizarov National Medical Research Centre for Traumatology and Orthopedics
- Issue: Vol 30, No 4 (2023)
- Pages: 409-418
- Section: Original study articles
- URL: https://ogarev-online.ru/0869-8678/article/view/254211
- DOI: https://doi.org/10.17816/vto568718
- ID: 254211
Cite item
Full Text
Abstract
BACKGROUND: Acetabular dysplasia combined with ischaemic deformity of the femoral head contributes to rapid progression of coxarthrosis in young adults. The issues of treatment tactics for this pathology remain unresolved.
AIM: Analysis of the immediate and mid-term results of extra-articular and intra-articular combined reconstructive interventions performed in patients with acetabular dysplasia combined with femoral head sphericity disorder.
MATERIALS AND METHODS: Treatment outcomes were studied in 23 patients with acetabular dysplasia associated with femoral head deformity. The average age at the operation was 19.0±1.2 years (14–34). The mean follow-up period was 3.4±0.4 years. Anatomical and functional results were evaluated according to the criteria of D’Aubigne-Postel, Tonnis and according to the Russian Scientific Center “Restorative Traumatology and Orthopedics” system. Extra-articular reconstructive interventions on both articular components were performed in 14 patients. In 9 cases, intra-articular operations were performed.
RESULTS: Functional results after extra-articular interventions: good (15–17 points) — 8 joints, satisfactory (12–14 points) — 6 joints. The average score was 5.05±0.06 points. Functional results after intra-articular interventions: good (15 points) — 3 joints, satisfactory (13–14 points) — 5 joints, unsatisfactory (7 points) — 1 joint. The average score is 4.3±0.07 points. Rapid progression of arthrosis was noted in one case. In other cases, the degree of arthrosis did not change. Anatomical results of treatment after extra-articular interventions: good (2.6±0.03) — 8 joints, satisfactory (1.95±0.06) — 6 joints. Anatomical results of treatment after intra-articular interventions: good (2.55±0.01) — 2 joints, satisfactory (2.1±0.04) –— 6 joints, unsatisfactory (1.6) — 1 joint.
CONCLUSION: Differential application of extra-articular and intra-articular joint-saving interventions makes it possible to slow down the progression of the pathological process in the joint in conditions of sphericity disturbance of the articular surfaces, which makes it possible to consider them as a temporary alternative to endoprosthesis in adolescents and young adults.
Full Text
##article.viewOnOriginalSite##About the authors
Mikhail P. Teplenky
Ilizarov National Medical Research Centre for Traumatology and Orthopedics
Email: teplenkiymp@mail.ru
ORCID iD: 0000-0002-1973-5192
SPIN-code: 6891-8377
MD, Dr. Sci. (Med.)
Russian Federation, KurganVyacheslav S. Bunov
Ilizarov National Medical Research Centre for Traumatology and Orthopedics
Email: bvsbunov@yandex.ru
ORCID iD: 0000-0002-5926-7872
SPIN-code: 5089-3928
MD, Cand. Sci. (Med.)
Russian Federation, KurganJonibek Т. Fozilov
Ilizarov National Medical Research Centre for Traumatology and Orthopedics
Author for correspondence.
Email: turdievich25081995@gmail.com
ORCID iD: 0000-0001-5068-6643
SPIN-code: 3901-1107
Russian Federation, Kurgan
References
- Shinoda T, Naito M, Nakamura Y, Kiyama T. Periacetabular osteotomy for the treatment of dysplastic hip with Perthes-like deformities. Int Orthop. 2009;33(1):71–75. doi: 10.1007/s00264-007-0476-9
- Chen M, Shang XF. Surgical treatment for young adult hip dysplasia: joint-preserving options. Int Orthop. 2016;40(5):891–900. doi: 10.1007/s00264-015-2927-z
- Edelstein AI, Duncan ST, Akers S, Pashos G, Schoenecker PL, Clohisy JC. Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities. J Hip Preserv Surg. 2019;6(2):117–123. doi: 10.1093/jhps/hnz014
- Clohisy JC, Ross JR, North JD, Nepple JJ, Schoenecker PL. What are the factors associated with acetabular correction in Perthes-like hip deformities? Clin Orthop Relat Res. 2012;470(12):3439–3445. doi: 10.1007/s11999-012-2507-0
- Okano K, Enomoto H, Osaki M, Shindo H. Joint congruency as an indication for rotational acetabular osteotomy. Clin Orthop Relat Res. 2009;467(4):894–900. doi: 10.1007/s11999-008-0443-9
- d’Aubigné RM, Postel M. The classic: functional results of hip arthroplasty with acrylic prosthesis. 1954. Clin Orthop Relat Res. 2009;467(01):7–27. doi: 10.1007/s11999-008-0572-1
- Okano K, Enomoto H, Osaki M, Takahasi K., Shindo H. Femoral head deformity after open reduction by Ludloff’s medial approach. Clin Orthop Relat Res. 2008;466(10):2507–2512. doi: 10.1007/s11999-008-0266-8
- Tönnis D. Congenital dysplasia and dislocation of the hip. Berlin: Springer-Verlag; 1987. 506 р.
- Teplenky M, Oleinikov E, Bunov V. Hip reconstruction in patients with ischemic deformity of the proximal femur and associated acetabular dysplasia. Genij Ortopedii. 2020;26(4):502–507. (In Russ). doi: 10.18019/1028-4427-2020-26-4-502-507
- Clohisy JC, Nepple JJ, Ross JR, Pashos G, Schoenecker PL. Does surgical hip dislocation and periacetabular osteotomy improve pain in patients with Perthes-like deformities and acetabular dysplasia? Clin Orthop Relat Res. 2015;473(4):1370–1377. doi: 10.1007/s11999-014-4115-7
- Lecuire F. The long-term outcome of primary osteochondritis of the hip (Legg-Calvé-Perthes’ disease). J Bone Joint Surg Br. 2002;84(5):636–640. doi: 10.1302/0301-620x.84b5.12124
- Yrjönen T. Long-term prognosis of Legg-Calvé-Perthes disease: a meta-analysis. J Pediatr Orthop B. 1999;8(3):169–172. doi: 10.1097/01202412-199907000-00005
- Haverkamp D. Intertrochanteric osteotomy combined with acetabular shelfplasty in young patients with severe deformity of the femoral head and secondary osteoarthritis. A long-term follow-up study. J Bone Joint Surg Br. 2005;87-B(1):25–31.
- Teplenky MP, Oleinikov EV, Bunov VS, Fozilov DT. Pelvic Osteotomies for Treatment of Young Patients With Hip Osteoarthritis Secondary to Developmental Dysplasia. Traumatology and Orthopedics of Russia. 2022;28(1):19–27. (In Russ). doi: 10.17816/2311-2905-1678
- Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am. 2007;89(7):1417–1423. doi: 10.2106/JBJS.F.00493
- Anderson LA, Erickson JA, Severson EP, Peters CL. Sequelae of Perthes disease: treatment with surgical hip dislocation and relative femoral neck lengthening. J Pediatr Orthop. 2010;30(8):758–766. doi: 10.1097/BPO.0b013e3181fcbaaf
- Tannast M, Macintyre N, Steppacher SD, Hosalkar HS, Ganz R, Siebenrock KA. A systematic approach to analyse the sequelae of LCPD. Hip Int. 2013;23(Suppl 9):S61–S70. doi: 10.5301/hipint.5000071
- Novais EN, Clohisy J, Siebenrock K, Podeszwa D, Sucato D, Kim YJ. Treatment of the symptomatic healed Perthes hip. Orthop Clin North Am. 2011;42(3):401–17. doi: 10.1016/j.ocl.2011.05.003
- Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;(363):93–99.
- Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res. 2008;466(4):782–790. doi: 10.1007/s11999-008-0141-7
- Yasunaga Y, Yamasaki T, Ochi M. Patient selection criteria for periacetabular osteotomy or rotational acetabular osteotomy. Clin Orthop Relat Res. 2012;470(12):3342–3354. doi: 10.1007/s11999-012-2516-z
- Perry KI, Trousdale RT, Sierra RJ. Hip dysplasia in the young adult: an osteotomy solution. Bone Joint J. 2013;95-B(11 Suppl A):21–25. doi: 10.1302/0301-620X.95B11.32633
- Hartig-Andreasen S, Troelsen A, Thillemann TM, Søballe K. What Factors Predict Failure 4 to 12 Years After Periacetabular Osteotomy? Clin Orthop Relat Res. 2012. 470(11):2978–87. doi: 10.1007/s11999-012-2386-4
- Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am. 2009;91(9):2169–79. doi: 10.2106/JBJS.H.00994
- Wells J, Millis M, Kim Y-J, Bulat E, Miller P, Matheney T. Survivorship of the Bernese Periacetabular Osteotomy: What Factors are Associated with Long-term Failure? Clin Orthop Relat Res. 2017;475(2):396–405. doi: 10.1007/s11999-016-4887-z
- Kamosko MM, Baskov VE, Barsukov DB, Pozdnikin IYu, Grigoriev IV. Transposition of the acetabulum after triple pelvic osteotomy in the treatment of children with hip dysplasia Traumatology and Orthopedics of Russia. 2014;20(3):76–85. (In Russ). doi: 10.21823/2311-2905-2014-0-3-76-85
- Shimogaki K, Yasunaga Y, Ochi M. A histological study of articular cartilage after rotational acetabular osteotomy for hip dysplasia. J Bone Joint Surg Br. 2005;87(7):1019–23. doi: 10.1302/0301-620X.87B7.15589
- Sen C, Sener N, Tozun R, Boynuk B. Polygonal triple (Kotz) osteotomy in the treatment of acetabular dysplasia 17 patients (19 hips) with 4–9 years of follow-up. Acta Orthop Scand. 2003;74(2):127–132. doi: 10.1080/00016470310013833
- Bortulev PI, Vissarionov SV, Bortuleva OV, Baskov VE, Barsukov DB, Pozdnikin IYu, Baskaeva TV. The Medium-Term Results of Complex Treatment of the Children with I–II Stage Dysplastic Osteoarthritis. Traumatology and Orthopedics of Russia. 2020;26(3):93–105. (In Russ). doi: 10.21823/2311-2905-2020-26-3-93-105
- Clohisy JC, Schutz A, John L, Schoenecker P, Wright R. Periacetabular Osteotomy: A Systematic Literature Review. Clin Orthop. 2009;467(8):2041–52. doi: 10.1007/s11999-009-0842-6
- Biedermann R, Donnan L, Gabriel A, Wachter R, Krismer M, Behensky H. Complications and patient satisfaction after periacetabular pelvic osteotomy. Int Orthop. 2008;32(5):611–617. doi: 10.1007/s00264-007-0372-3
Supplementary files
