Osteotomy For Dysplastic Hip
The treatment for these is a periacetabular osteotomy. In the past large incisions were used but now with latest equipment minimally invasive osteotomy (Figure 8) is the standard procedure, with the length of the skin incision being between 8-10 cm.
Osteotomies of the pelvis and/or femoral osteotomies can alter force transmission through the hip joint and thus potentially influence clinical symptoms and the course of the OA process. For patient with actabular dysplasia the most established procedure is a Bernese periacetabular osteotomy although there may be a small role for Chiari and Shelf osteotomies in non-congruent hips. Proximal femoral osteotomies may be beneficial in patients with proximal femoral deformities and will be dictated by the pathology. However, caution should be taken with regards the need for future total hip replacement. With the success of Bernese periacetabular osteotomies and its good long-term results the role of alternative osteotomies is very limited.
Bernese periacetabular osteotomies lead to anatomical restoration of biomechanics and improves femoral head cover without compromising the pelvic volume, which is critical for child-bearing age. The abductors and posterior column are left intact allowing earlier weight bearing and quicker healing. The osteotomy was conventionally performed using modified Smith-Peterson approach but minimally invasive approaches have been described with lesser soft tissue dissection, which allows quicker rehabilitation, reduced blood loss and decrease in complication rate. Good long- term results can be expected in young patients, where the process of damage is not advanced.