CLINICAL RESULTS OF TRIPLE PELVIC OSTEOTOMY FOR DYSPLASTIC COXARTROSIS IN ADULTS
https://doi.org/10.29235/1814-6023-2018-15-1-55-67
Abstract
The article presents a comparison analysis of clinical results of treatment of 67 patients who underwent triple pelvic osteotomy (81 cases) by A. M. Sokolovsky in the two groups. The control group consisted of 33 patients (40 operational interventions), who were operated according to the original technique of the author. The main group consisted of 34 patients who underwent 41 triple osteotomy of the pelvis using the modifications we proposed.
Clinical assessment of the condition of the affected joints was performed according to the system proposed by Tschauner. When assessing the long-term results with a median follow-up of 107.5 (40–171) months in the control group, we obtained excellent and good results in 47.5 % of the cases. In the main groupwith a median follow-up of 107 (42–168) months excellent and good results were 70.8 % of the cases. When performing the operation with the modified technology, we obtained a significantly reduced number of complications in the form of nonunion of the pelvic bones from 35.0 to 14.6 %.
Triple pelvic osteotomy according to A. M. Sokolovsky is a highly effective intervention capable of restoring normal or close to normal biomechanical conditions of dysplastic hip joint functioning in adults and should be considered as a surgery of choice. Use of the proposed variants of the osteotomy of the ischial bone and more rigid fixation of an acetabular fragment, replacement of defects in the sites of osteotomy after the reorientation of the acetabulum with bone grafts reduces the number of complications and improves the treatment results.
About the Authors
Ivan Z. Minakouski
RepublicanScientificandPractical Center of Traumatology and Orthopedics
Belarus
Belarus
Head of the Department
60, Bld. 4, Kizhevatov Str., 220024, Minsk
Aleh A. Sakalouski
RepublicanScientificandPractical Center of Traumatology and Orthopedics
Belarus
Belarus
D. Sc. (Med.), Professor, Head of the Laboratory
60, Bld. 4, Kizhevatov Str., 220024, Minsk
Alexandr V. Beletski
RepublicanScientificandPractical Center of Traumatology and Orthopedics
Belarus
Belarus
Academician, D. Sc. (Med.), Professor, Director
60, Bld. 4, Kizhevatov Str., 220024, Minsk
References
1. Sokolovskiy A. M., Kryuk A. S. Surgical treatment of hip joint disease. Minsk, Navuka i tekhnika Publ., 1993. 248 p. (in Russian).
2. Hailer N. P., Soykaner L., Ackermann H., Rittmeister M. Triple osteotomy of the pelvis for acetabular dysplasia: age at operation and the incidence of nonunions and other complications influence outcome. Journal of Bone and Joint Surgery (Br.), 2005, vol. 87-B, no. 12, рр. 1622–1626. DOI: 10.1302/0301-620x.87b12.15482
3. Shevchenko S. D., Polozov Y. G., Mischeryakov A. G. Corrective osteotomy of the femur in the treatment of dysplastic hip joint syndrome. Ortopediya, travmatologiya i protezirovanie = Orthopedics, traumatology and prosthetics, 1991, no. 5, pp. 46–52 (in Russian).
4. Tönnis D., Arning A., Bloch M., Heinecke A., Kalchschmidt K. Triple pelvic osteotomy. Journal of Pediatric Orthopaedics. Ser. B, 1994, vol. 3, no. 1, рр. 54–67. DOI: 10.1097/01202412-199403010-00011
5. Murphy S. B., Kijewski P. K., Millis M. B., Harless A. Acetabular dysplasia in the adolescent and young adult. Clinical Orthopaedics and Related Research, 1990, vol. 261, рр. 214–223. DOI: 10.1097/00003086-199012000-00023
6. Millis M. B., Murphy S. B., Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Journal of Bone and Joint Surgery, 1995, vol. 77, no. 4, рp. 626–647. DOI: 10.2106/00004623-199504000-00018
7. Mitskevich V. A., Zhilyaev A. A., Popova T. P. Clinical-biomechanical assessment of hip joint function in coxarthrosis. Vestnik travmatologii i ortopedii imeni N. N. Priorova [Herald of Traumatology and Orthopedics named after N. N. Priorov], 1999, no. 4, pp. 38–43 (in Russian).
8. Bryant M. J., Kernohan W. G., Nixon J. R., Mollan R. A. A statistical analysis of hip scores. Journal of Bone and Joint Surgery (Br.), 1993, vol. 75-B, no. 5, рр. 705–709.
9. Mimura T., Mori K., Kawasaki T., Imai S., Matsusue Y. Triple pelvic osteotomy: Report of our mid-term results and review of literature. World Journal of Orthopedics, 2014, vol. 5, no. 1, рр. 14–22. DOI:10.5312/wjo.v5.i1.14
10. Minakouski I. Z., Sakalouski O. A. Evolution of the dysplastic pelvic joint in adults after triple osteometomy of the pelvis. Medicina = Medicine, 2017, no. 3, pp. 4–13 (in Russian).
11. Sokolovskii O. A., Beletskii A. V., Minakovskii I. Z., Dementsov A. B., Shpilevskii I. E., Serdyuchenko S. N., Likhachevskii Yu. V. Mode of osteotomy of the ischia. Patent Republic of Belarus no. 13185, 2010 (in Russian).
12. Sokolovskii O. A., Beletskii A. V., Dementsov A. B., Minakovskii I. Z., Serdyuchenko S. N., Koval’chuk O. V., Likhachevskii Yu. V. Mode of osteotomy of the ischia. Patent Republic of Belarus no. 13186, 2010 (in Russian).
13. Tschauner C., Klapsch W., Kohlmeier W. Die dreifache Beckenosteotomie nach Tonnis im Rahmen der Spatdysplasie und frühen Sekundärarthrose des Hüftgelenkes. Orthopädische Praxis, 1992, Bd. 28, S. 255–263.
14. Dal Monte A. Marchiodi L., Soncini G., Valdiserri L. Long term results of tridohate osteotomy of the pelvis. A follow-up study of 26 hips. Italian Journal of Orthopaedics and Traumatology, 1985, vol. 11, no. 4, pp. 403–408.
15. Vukasinovic Z., Pelillo F., Spasovski D., Seslija I., Zivkovic Z., Matanovic D. Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications. Hip International, 2009, vol. 19, no. 4, pp. 315–322.
16. Tschauner C., Sylkin A., Hofmann S., Graf R. Painful nonunion after triple pelvic osteotomy. Journal of Bone and Joint Surgery (Br.), 2003, vol. 85-B, no. 7, pp. 953–955. DOI: 10.1302/0301-620X.85B7.1417
17. Birnbaum K., Pastor A., Prescher A., Heller K.-D. Complications of Chiari and Salter osteotomies a cadaver study. Surgical and Radiologic Anatomy, 2001, vol. 22, no. 5–6, pp. 225–233. DOI: https://doi.org/10.1007/s00276-000-0225-x
18. Faciszewski T., Coleman S. S., Biddulph G. Triple innominate osteotomy for acetabular dysplasia. Journal of Pediatric Orthopaedics, 1993, vol. 13, no. 4, pp. 426–430. DOI: 10.1097/01241398-199307000-00002
19. Dungl P., Rejholec M., Chomiak J., Grill F. The role of triple pelvic osteotomy in therapy of residual hip dysplasia and sequel of AVN: long-term experience. Hip International, 2007, vol. 17, iss. suppl. 5, pp. 51–64. DOI:10.5301/hip.2008.2207
20. Kooijman M. A., Pavlov P. W. Triple osteotomy of the pelvis. A review of 51 cases. Clinical Orthopaedics and Related Research, 1990, vol. 255, pp. 133–137. DOI: 10.1097/00003086-199006000-00019
21. Kumar S. J., MacEwen G. D., Jaykumar A. S. Triple osteotomy of the innominate bone for the treatment of congenital hip dysplasia. Journal of Pediatric Orthopaedics, 1986, vol. 6, no. 4, pp. 393–398. DOI: 10.1097/01241398-198607000-00001
22. Peters C. L., Fukushima B. W., Park T. K., Coleman S. S., Dunn H. K. Triple innominate osteotomy in young adults for the treatment of acetabular dysplasia: a 9-year follow-up study. Orthopedics, 2001, vol. 24, no. 6, pp. 565–569.
23. Janssen D., Kalchschmidt K., Katthagen B.-D. Triple pelvic osteotomy as treatment for osteoarthritis secondary to developmental dysplasia of the hip. International Orthopaedics, 2009, vol. 33, no. 6, pp. 1555–1559. DOI: 10.1007/s00264- 008-0718-5
24. Von Bremen-Kühne R., de la Vega-Salgado H., Steffen R. Triple pelvic osteotomy (according to Tönnis and Kalchschmidt) in the treatment of acetabular dysplasia – medium-term results. Zeitschrift für Orthopädie und Unfallchirurgie, 2006, vol. 144, no. 5, pp. 484–491. DOI: 10.1055/s-2006-942167
25. Kryuk A. S., Sokolovskiy A. M. Early manifestations and surgical treatment of dysplastic coxarthrosis. Ortopediya, travmatologiya i protezirovanie = Orthopedics, traumatology and prosthetics, 1982, no. 10, pp. 8–14 (in Russian).
26. Tachdjian M. Pediatric Orthopedics. 4 vol. New York, Churchill-Livingston, 1990.
Review
For citations:
Minakouski I.Z., Sakalouski A.A., Beletski A.V. CLINICAL RESULTS OF TRIPLE PELVIC OSTEOTOMY FOR DYSPLASTIC COXARTROSIS IN ADULTS. Proceedings of the National Academy of Sciences of Belarus, Medical series. 2018;15(1):55-67. (In Russ.) https://doi.org/10.29235/1814-6023-2018-15-1-55-67
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