PELVIC OSTEOTOMY IN MANAGEMENT OF CONGENITAL DYSPLASIA OF THE HIP

Abstract

Despite neonatal screening and early treatment of congenital dislocation of the hip, it is not uncommon to see an older child with untreated, neglected congenital dislocation of the hip. For these children with well­ established hip dysplasia, open reduction with femoral or pelvic osteotomy, or both, is often required.

Prior to the performance of surgical procedures used for treatment of CDH, it is important to study the developmental anatomy of the hip joint, pathogenesis of hip dysplasia and pathological anatomy of different elements of dysplastic hips. Imaging techniques are used to complete this study including conventional radiography, arthrography, computed tomography, MRI and ultrasonography.

Open reduction can be performed as a treatment modality. During open reduction and before closure of the capsule, a test of stability can be done as an aid to decide the need for femoral or pelvic osteotomy or both. Persistent dysplasia can be corrected by a redirectional proximal femoral osteotomy in very young children.

Pelvic osteotomies are performed to correct a deficient acetabulum that is providing inadequate coverage for the femoral head and prevent or correct subluxation and dislocation of the hip. The goal of pelvic osteotomies is to reorient the acetabular weight-bearing surface over• the femoral head so that the area of direct weight bearing is increased. This decreases load per unit area and results in slowing econdary degenerative changes and reducing pain.