Acetabular remodeling after graft extrusion, rotation or impaction in Dega and Pemberton acetabuloplasties for developmental dysplasia of the hip.

Traditionally graft displacement following Pemberton and Dega acetabuloplasties involves internal fixation for treatment of developmental dysplasia of hip (DDH). This study was performed to assess the acetabular remodeling by conservative management of graft displacement among patients with DDH. This was a retrospective study of 20 patients 17 (85%) women and 3 (15%) men; mean age 22.90 ± 6.96 months with DDH who underwent Pemberton and Dega acetabuloplasties at King Khalid University Hospital, Riyadh between January 2013 and January 2018. All patients after losing acetabular correction during immediate postoperative period were treated by conservative management. The management involved application of Spica cast for 6 weeks that was trimmed to broomstick cast for an extended period of time and finally replaced by nocturnal abduction brace until normal acetabular index (AI) was achieved. The patients were followed up for a mean period of 44.60 ± 12.36 months. Out of the total, 18 (90%) patients with DDH were successfully treated by conservative management. The mean preoperative AI of 43.70° ± 5.91° improved to 21.35o ± 6.32o at the final follow-up (P < 0.001) which was no different when compared to the mean of unaffected hips (19.70o ± 2.96o; P < 0.44). The mean preoperative CEA of all the patients was negative that improved during the conservative treatment to 29.20° ± 10.0° which was no different when compared with the mean of unaffected (31.70° ± 4.64o; P = 0.32) hips at the final follow-up. doption of less aggressive approach for management of displaced, rotated or impacted autograft following acetabuloplasties among children with DDH was not only a useful conservative approach for remodeling of hips but also obviated the need for additional surgical intervention.

The Vascularization Course of Labral Autograft and Its Effect on Tissue Healing: Acetabular Labral Augmentation Versus Labral Reconstruction in a Porcine Model.

BACKGROUND: The preservation of the native labral vascularization is assumed to be the potential advantage of acetabular labral augmentation, the effect of which remains unknown. PURPOSE: To identify the vascular distribution within the labral autograft and its effect on the healing process between labral augmentation (AUG) and reconstruction (RECON) in a porcine model. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 36 pigs randomly underwent unilateral labral augmentation or reconstruction (AUG group, n = 18; RECON group, n = 18). The pigs were randomly sacrificed at 6, 12, and 24 weeks postoperatively. The labral autografts were harvested for macroscopic evaluation and histologic assessment. The labral autograft was zoned into 2 halves to observe the vascular distribution: the capsular half (zone I) and the articular half (zone II). Each zone was divided into 2 parts: the peripheral part (IA and IIA) and the part attached to the acetabulum (IB and IIB). RESULTS: At 6 weeks, there existed more vascular ingrowth in zone I, whereas zone IIB appeared nearly avascular in both groups. At 12 weeks, the area with the greatest vascularity was zone II in the RECON group and zone IA in the AUG group. The vascularity was concentrated at zones IA and IIA in both groups at 24 weeks. The labral autografts were hypertrophic with sufficient filling of the labral defect in both groups at 6 weeks. At 12 weeks, an insufficient volume of the articular half was observed in 3 of 6 labral autografts in the RECON group, while all autografts remained well integrated with the chondrolabral junction in the AUG group. At 24 weeks, unsatisfactory merging of the labral autograft with the cartilage at the articular side was found in 2 of 6 labral autografts in the RECON group, which was not observed in the AUG group despite the sufficient volume of autografts labrum in both groups. CONCLUSION: Slow vascular ingrowth within the articular half might account for the poor healing of the reconstructed labral autograft. Labral augmentation provides the possibility of better tissue healing because of the preservation of the original chondrolabral junction compared with labral reconstruction. CLINICAL RELEVANCE: Labral augmentation might be a feasible alternative to labral reconstruction under the condition of viable labral remnants.

Early and mid-term results of Tönnis lateral acetabuloplasty for the treatment of developmental dysplasia of the hip.

OBJECTIVES: This study aimed to present the clinical and radiological results of a large patient group operated by Tönnis lateral acetabuloplasty (TLA) for developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: The retrospective study was conducted with 66 hips of 41 patients (5 males, 36 females; mean age: 32.3±18 months; range, 11 to 132 months) operated for DDH using the TLA technique in a single center between February 2012 and December 2016. Adductor tenotomy was performed on 52 (79%) hips. There was a need for additional femoral shortening and derotation-varization osteotomy in 14 (21%) hips. Clinical outcomes were evaluated with modified McKay criteria. The acetabular index and lateral migration index for the subluxated hip were calculated, and the femoral head position was evaluated according to Perkin's line and Shenton's line. The Severin classification was used to assess the outcome of the hips. RESULTS: The mean follow-up period was 27±11 months. According to the modified McKay criteria for DDH, 77.3% of hips were classified as excellent, 16.6% as good, and 6.1% as fair. The mean acetabular index decreased from 36.1° preoperatively to 18.6° postoperatively. The mean postoperative improvement for the acetabular index was 17.5±5. The lateral migration index improved from 89.7 to 10.6%. A statistically significant difference was determined between the preoperative and postoperative measurements of the acetabular index and lateral migration index (p<0.001). CONCLUSION: Tönnis lateral acetabuloplasty was found to be safe and effective with a low learning curve, and successful treatment decreases the duration of follow-up required in patients with DDH.

Incidence and risk factors of preoperative deep venous thrombosis following pelvic and acetabular fractures: a retrospective case-control study.

The objective of this study was to investigate the prevalence of preoperative deep venous thrombosis (DVT) in the pelvic cavity and lower extremities following pelvic and acetabular fractures and to identify the risk factors of the occurrence of DVT. Duplex ultrasound (DUS) screening and blood tests were conducted in patients admitted from June 2012 to December 2020 for surgical treatment of pelvic and acetabular fractures. Univariate analyses were performed on data of demographics, comorbidities, time from injury to surgery, injury mechanism, accompanied injury, and laboratory results. The optimal cutoff values of continuous variables with statistical significance were obtained by using the receiver operating characteristic (ROC) curve. A multivariate logistic regression analysis was then employed to examine the independent values in terms of predicting preoperative DVT. A total of 607 patients with pelvic and acetabular fractures were included, among whom 82 (13.5%) patients sustained preoperative DVTs. Specifically, 31.7% (26/82) were diagnosed with proximal DVTs. Fifty-two (63.4%) patients had DVT within 7 days after injury, and 67 (81.7%) patients within 10 days. The multivariate logistic regression analysis identified 6 factors independently associated with the presence of preoperative DVT, including age > 46 years (odds ratio [OR] = 2.94), BMI > 26.73 kg/m2 (OR = 3.91), time from injury to surgery > 9 days (OR = 5.39), associated injury (OR = 7.85), ALB < 32.8 g/L (OR = 2.71) and FIB > 3.095 g/L (OR = 3.34). Despite the modern prophylactic regimen, the preoperative DVT in patients with pelvic and acetabular fractures still draws the attention of orthopaedic surgeons. Better understanding these risk factors can help surgeons refine the risk stratification profile and perform early interdisciplinary management for patients at high risk of DVT.

Influence of shelf acetabuloplasty on the outcomes of total hip arthroplasty in hips with dysplasia: a case-control study.

INTRODUCTION: Total hip arthroplasty (THA) in young adults, especially in those with hip dysplasia, is affected by wear and acetabular fixation problems. Shelf acetabuloplasty is performed to delay THA in patients with acetabular dysplasia. Thus, we conducted a retrospective, continuous case-control study at a single healthcare facility to analyze (1) the influence of prior shelf acetabuloplasty on the survival of a subsequent THA and (2) the functional outcomes. MATERIALS AND METHODS: We evaluated 105 patients (124 THA) who underwent THA due to hip dysplasia: 54 patients (61 THA) were included in the THA post-shelf acetabuloplasty group (case group) and 51 patients (63 THA) in the THA for dysplasia group (control group). RESULTS: At 15 years' follow-up, 89% of patients (95% CI: 84-91%) in the shelf group and 83% (95% CI: 81-90%) in the dysplasia group had not undergone surgical revision. This difference between groups was not statistically significant (p = 0.566). The functional outcomes were satisfactory in both groups; however, they were significantly better in the dysplasia group than in the shelf group based on the Merle d'Aubigne and Postel score (16.9 vs 16.0 min-max: 14-18 vs 3-18) (p = 0.01), Harris Hip score (90.0 vs 84.7, min-max: 62-100 vs 22-100) (p = 0.017), and the Oxford-12 (18/60 vs 21/60, min-max: 45-12 vs 51-12) (p = 0.04). CONCLUSION: Shelf acetabuloplasty before THA does not negatively affect THA survivorship. The functional outcomes appear to be better in the hips that did not undergo shelf acetabuloplasty, although the results were good in both groups.

3-D acetabular morphology of the neuromuscular hip: implications for preoperative planning.

The importance of precisely understanding the pathoanatomy of acetabular dysplasia prior to surgical treatment has long been recognized. Acetabuloplasties for neuromuscular hip dysplasia have typically aimed to improve the acetabulum by increasing posterior-superior coverage, as previous three-dimensional (3-D) computed tomography (CT) studies have shown that acetabular dysplasia in neuromuscular hips is primarily in the direction of posterior-superior subluxation or dislocation. The purpose of this study was to identify differences in 3-D morphology between normal hips and dysplastic neuromuscular hips, specifically to identify areas of acetabular deficiency to guide preoperative decision-making. Patients treated for neuromuscular hip dysplasia at a single institution between 2009 and 2017 with a preoperative high-resolution pelvic CT scan (28 hips) were evaluated with custom software to measure acetabular morphology. Acetabuli were divided into equal octants; coverage angles were measured for each octant of interest. Variables were compared with age- and sex-matched normal controls (56 hips). We found a wide range of hip pathology in our study cohort. Five hips had no sectors with abnormal coverage. One hip (4%) was overcovered anteriorly. The remaining pathology was undercoverage located anteriorly [n = 7 (25%)], superiorly [n = 6 (21%)], posteriorly [n = 4 (14%)] or globally [n = 5 (18%)]. Our findings indicate that individual patients with neuromuscular acetabular dysplasia have unique deformities that do not uniformly conform to a specific area of acetabular deficiency. It is imperative to define the specific 3-D acetabular deficiency location and magnitude for accurate preoperative planning. Level of evidence: Level III.

Isolated Acetabuloplasty for Femoroacetabular Impingement: Favorable Patient-Reported Outcomes and Sustained Survivorship at Minimum 5-Year Follow-Up.

PURPOSE: To evaluate minimum 5-year outcomes and conversion rate to total hip arthroplasty (THA) for the treatment of femoroacetabular impingement (FAI) syndrome with an isolated acetabular osteoplasty. METHODS: Patients undergoing hip arthroscopy with an isolated acetabular osteoplasty from March 2009 to June 2014 for FAI syndrome with pincer and/or cam morphology and a labral tear were identified. Those who underwent femoroplasty or prior ipsilateral hip surgery or who had previous hip conditions, ipsilateral hip dysplasia, or a Tönnis grade higher than 2 were excluded. Patient-reported outcomes (PROs) collected included Patient-Reported Outcomes Measurement Information System (PROMIS) scores specific to physical functioning and pain interference, modified Harris Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and Numeric Pain Rating Scale. Patients were also queried about secondary surgical procedures and conversion to THA. RESULTS: We identified 86 patients at minimum 5-year follow-up (average, 7.4 years). The average patient age was 39.8 ± 12.3 years, 70.9% of patients were female, and 7% of patients had Tönnis grade 2. The mean PRO scores were 52.0 ± 8.9 for the PROMIS physical functioning score, 39.6 ± 7.5 for the PROMIS pain interference score, 78.7 ± 12.0 for the modified Harris Hip Score, 73.3 ± 23.1 for the International Hip Outcome Tool 12 score, 89.9 ± 12.0 for the Hip Outcome Score-Activities of Daily Living, and 81.4 ± 21.0 for the Hip Outcome Score-Sport-Specific Subscale. Of the patients, 72.1% achieved the patient acceptable symptomatic state (PASS) according to previously established PASS scores for FAI syndrome treated with hip arthroscopy at minimum 5-year follow-up. The overall rate of revision arthroscopy was 3.5%, and the rate of conversion to THA was 5.8%. CONCLUSIONS: An isolated acetabular osteoplasty can provide sustained clinical benefits for the treatment of FAI syndrome with labral tears, with good to excellent PROs and PASS rates and a low rate of conversion to THA at minimum 5-year follow-up. LEVEL OF EVIDENCE: Level IV, case series.

Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure.

BACKGROUND: Reconstruction after pelvic tumor resection of the acetabulum is challenging. Previous methods of hip transposition after acetabular resection have the advantages of reducing wound complications and infections of the allograft or metal endoprosthesis but were associated with substantial limb length discrepancy. We therefore developed a modification of this procedure, rotation hip transposition after femur lengthening, to address limb length, and we wished to evaluate its effectiveness in terms of complications and functional outcomes. QUESTIONS/PURPOSES: In this study, we asked: (1) What were the Musculoskeletal Tumor Society scores after this reconstruction method was used? (2) What complications occurred after this reconstruction method was used? (3) What proportion of patients achieved solid arthrodesis (as opposed to pseudarthrosis) with the sacrum and solid union of the femur? (4) What were the results with respect to limb length after a minimum follow-up of 2 years? METHODS: From 2011 to 2017, 83 patients with an aggressive benign or primary malignant tumor involving the acetabulum were treated in our institution. Of those, 23% (19 of 83) were treated with rotation hip transposition after femur lengthening and were considered for this retrospective study; 15 were available at a minimum follow-up of 2 years (median [range], 49 months [24 to 97 months]), and four died of lung metastases before 2 years. No patients were lost to follow-up before 2 years. During the period in question, the general indications for this approach were primary nonmetastatic malignant bone tumor or a locally aggressive benign bone tumor that could not be treated adequately with curettage. There were seven men and 12 women with a median age of 43 years. Nine patients underwent Zones I + II resection, eight patients had Zones I + II + III resection, and two received Zones II + III resection. After tumor resection, rotation hip transposition after femur lengthening reconstruction was performed, which included two steps. The first step was to lengthen the femur with the insertion of an allograft. Two methods were used to achieve limb lengthening: a "Z" osteotomy and a transverse osteotomy. The second step was to take the hip transposition and rotate the femoral head posteriorly 10° to 20°. The median (range) operative time was 510 minutes (330 to 925 minutes). The median intraoperative blood loss was 4000 mL (1800 to 7000 mL). We performed a chart review on the 15 available patients for clinical and radiographic assessment of functional outcomes and complications. Arthrodesis and leg length discrepancy were evaluated radiographically. RESULTS: The median (range) Musculoskeletal Tumor Society score was 21 points (17 to 30). Eleven of 19 patients developed procedure-related complications, including six patients with allograft nonunion, two with deep infection, two with delayed skin healing, and one with a hematoma. Two patients had minor additional surgical interventions without the removal of any implants. Local recurrences developed in four patients, and all four died of disease. All seven patients treated with a Z osteotomy had bone union. Among the eight patients with transverse osteotomy, bone union did not occur in six patients. After hip transposition, stable iliofemoral arthrodesis was achieved in seven patients. Pseudarthrosis developed in the remaining eight patients. The median (range) lower limb length discrepancy at the last follow-up visit or death was 8 mm (1 to 42 mm). CONCLUSION: Although complex and challenging, rotation hip transposition after femur lengthening reconstruction with a Z osteotomy provides acceptable functional outcomes with complications that are within expectations for resection of pelvic tumors involving the acetabulum. Because of the magnitude and complexity of this technique, we believe it should be used primarily for patients with a favorable prognosis, both locally and systemically. This innovative procedure may be useful to other surgeons if larger numbers of patients and longer-term follow-up confirm our results. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients.

PURPOSE: This study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2 years follow-up. METHODS: Prospective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non-operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60 years, Tönnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36 years (range 16-59). RESULTS: The median alpha angle correction was 22.6º (range 5.9-46.7) (p < 0.01) and the average LCEA correction when acetabuloplasty was undertaken was 6.5º (range - 1.4-20.8) (p < 0.01). The mean NAHS at baseline was 56.1 (range 16-96) and improved to 83.2 at the last follow up (range 44-100) for the patients that had no additional procedure (p < 0.01). The mean average improvement was 27.7º points (range - 16-73). No iatrogenic labral perforation and no full-thickness chondral damage were recorded during the arthroscopic procedures. CONCLUSIONS: Favourable outcomes are reported for the arthroscopic treatment of FAI with initial access to the peripheral compartment. The technique is protective against iatrogenic chondral and labral damage, more conservative to the joint capsule, but the mean traction time was relatively long when suture anchors were used. The results are comparable to the classic initial central compartment approach. LEVEL OF EVIDENCE: Level IV.

No Correlation Between Depth of Acetabuloplasty or Postoperative Lateral Center-Edge Angle on Midterm Outcomes of Hip Arthroscopy With Acetabuloplasty and Labral Repair.

BACKGROUND: The treatment of pincer deformity in hip arthroscopy remains controversial, with some authors advocating that over resection may risk early joint deterioration. The role of acetabular resection depth and postoperative acetabular morphology on postoperative outcomes has yet to be defined. PURPOSE/HYPOTHESIS: This study measures the influence of acetabular resection depth and postoperative lateral center-edge angle (LCEA) on minimum 5-year patient-reported outcomes (PROs), revision rates, and conversion to total hip arthroplasty using a single surgeon's prospective database. We hypothesized that patients with acetabular resections >10°, as measured by LCEA, or patients with postoperative LCEA outside the normal range of 25° to 35° would have lower PROs, higher revision rates, and higher conversion to total hip arthroplasty at midterm follow-up. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 192 patients who underwent primary hip arthroscopy with acetabuloplasty and labral repair by a single surgeon with a minimum 5-year follow-up met the inclusion criteria. Preoperative and postoperative LCEAs were measured on supine anteroposterior radiographs, and patients were divided into cohorts based on LCEA and acetabular resection depth. Cohorts for postoperative LCEA were <20° (dysplasia), 20° to 25° (borderline dysplasia), 25° to 35° (normal), and >35° (borderline overcoverage). Cohorts for acetabular resection depth were <5°, 5° to 10°, and >10° difference from preoperative to postoperative LCEA. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short Form Health Survey, modified Harris Hip Score, Hip Outcome Score, satisfaction scores, revision rates, and conversion to arthroplasty rates. RESULTS: Patients significantly improved in all outcome score measures at final follow-up. There were no statistically significant differences in PRO scores or conversion to total hip arthroplasty between any cohorts in the postoperative LCEA group. There were more revisions in the 25° to 35° cohort than the other cohorts (P = .02). The 5-10° resection depth cohort demonstrated a higher postoperative WOMAC score (P = .03), but otherwise no statistically significant differences were seen between resection depth cohorts in the remaining postoperative outcomes scores, revision rates, or conversion to total hip arthroplasty rates. CONCLUSION: Patients with postoperative LCEA values outside the normal reference range and with large resections perform similar to those with normal postoperative LCEA values and smaller resections at a minimum 5-year follow-up.

Mid- and long-term outcome of Salter's, Pemberton's and Dega's osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis.

INTRODUCTION: Early diagnosis and early treatment have become the gold standard for management of developmental dysplasia of the hip. Surgery is required in case of failed initial treatment. Innominate pelvic osteotomy of Salter (SIO), Pemberton's pericapsular osteotomy (PPO) and Dega's acetabuloplasty (DA) are among the most used procedures.We performed a systematic review and meta-analysis of the past 57 years in order to assess the mid- and long-term outcome of these techniques. METHODS: Studies met inclusion criteria if they: (1) reported at least 5 cases treated by 1 of the abovementioned surgical techniques; (2) included children aged between 1 and 8 years; (3) surgical indication was late detected DDH or a failed initial treatment; (4) presented a minimal follow-up of 24 months; (5) reported the radiological score of Severin and/or the clinical score of McKay.Clinical and radiological outcomes were dichotomised into favourable and unfavourable outcome and weighted summary rates were determined using meta-analysis models. RESULTS: From a total of 7391 articles, 48 level of evidence grade IV articles were included in our review. A total of 2143 cases with a mean follow up of 112.4 months were included.Pooled Severin score indicated a statistically better outcome for PPO and DA compared to SIO (p = 0.0003 and p = 0.002, respectively). By dichotomising the results in favourable and unfavourable outcome, PPO showed the best results (p = 0.0002 vs. SIO, p = 0.01 vs. DA).Pooled McKay score showed a statistically better outcome for PPO and DA compared to SIO (p < 0.0001 and p = 0.03, respectively) as well as better outcomes for PPO compared to DA (p = 0.01). By dichotomising the results in favourable and unfavourable, PPO showed the best results. CONCLUSIONS: Even if our review demonstrates slightly better radiological and clinical results with the PPO, the currently available and limited data do not allow for clear recommendation towards one of these techniques.

Clinical and radiological outcomes of combined acetabuloplasty with acetabular redirectional osteotomy and femoral shortening for children older than 9 years of age with developmental dysplasia of the hip: a retrospective case series.

Developmental dysplasia of the hip (DDH) is a challenging pediatric condition. This study aimed to investigate the feasibility and the efficacy of Dega osteotomy in combination with pelvic triple osteotomy or periacetabular osteotomy and femoral shortening with derotational osteotomy for the treatment of severe acetabular deformity secondary to DDH in children older than 9 years of age. The clinical data of 22 children treated at our institution were retrospectively collected. Pre- and postoperative hip radiographs were evaluated. Center-edge (CE) angle was measured, and Severin classification and McKay criteria were used to evaluate the final outcome. Twenty-two patients (including 21 female patients) were treated during the study period. The mean age was 10.9 years (range 9.1-14.8). All patients had preoperative Tonnis grades III and IV dislocated hips. Mean follow-up time was 25.7 months (range 14-48). All but three hips underwent open reduction. All had concomitant proximal femoral shortening and derotation osteotomy. At last follow-up visit, all hips remained located and no cases of avascular necrosis were recorded. All patients had Severin grade I-II hips at last follow-up. According to McKay criteria, clinical outcome was excellent in three patients, good in seven, and fair in 12 patients. Acetabuloplasty in combination with periacetabular osteotomy and femoral shortening with derotational osteotomy is a valid and effective treatment for children older than 9 years of age with severe acetabular deformity secondary to DDH. Although the early clinical outcome of the reported procedure is favorable, further studies are necessary to evaluate the long-term effects of the reported technique.

Periacetabular Osteotomy as a Salvage Procedure: Early Outcomes in Patients Treated for Iatrogenic Hip Instability.

BACKGROUND: A periacetabular osteotomy (PAO) can reduce pain and improve quality of life in patients with hip dysplasia. While its utility for patients without traditional radiographic parameters for hip dysplasia has not been previously established, the PAO may help treat patients with hip instability that does not improve following single or multiple hip arthroscopic procedures, or when such procedures lead to hip instability. METHODS: A single-surgeon registry of patients at a single institution was queried to identify patients with a lateral center-edge angle (LCEA) of ≥24° and a Tönnis angle of <10° who underwent PAO because of hip pain and/or instability that failed treatment with hip arthroscopy. Descriptive summary statistics were reported on patient demographics, mean change in LCEA, and patient-reported outcome measures, including the modified Harris hip score (mHHS) and the International Hip Outcome Tool-33 (iHOT-33), at a minimum of 6 months of follow-up. RESULTS: Among 25 patients (mean age, 27.3 ± 6.9 years; 100% women), the mean LCEA increased from 27.2° (range, 24° to 37°) preoperatively to 39.0° ± 5.1° postoperatively (net increase, 11.8° ± 4.5°). Overall, the mean improvement in the mHHS was 11.5 ± 16.9 (preoperative, 59.4 ± 11.6; postoperative, 70.9 ± 20.6) and the mean improvement in the iHOT-33 was 23.8 ± 23.6 (preoperative, 32.2 ± 17.2; postoperative, 56.0 ± 30.0). Eighteen patients (72%) achieved a minimal clinically important improvement in mHHS (mean improvement, 17.4 ± 12.9) and iHOT-33 (mean improvement, 32.4 ± 19.1) scores. In comparison with 7 patients who did not show improvement, the 18 patients who showed improvement had significantly greater mean baseline patient-reported outcome scores. CONCLUSIONS: To our knowledge, these findings provide the first report on outcomes of PAO in patients with hip pain following arthroscopy who do not meet the traditional criteria for acetabular dysplasia. Early benefits in clinical outcomes suggest a novel surgical indication for PAO as a potential salvage option for selected patients; however, longer-term studies are needed. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Traditional three-dimensional printing technology versus three-dimensional printing mirror model technology in the treatment of isolated acetabular fractures: a retrospective analysis.

OBJECTIVE: This study was performed to compare the clinical outcomes of traditional three-dimensional (3D) printing technology and 3D printing mirror model technology in the treatment of isolated acetabular fractures. METHODS: Prospectively maintained databases were reviewed to retrospectively compare patients with an isolated acetabular fracture who were treated with traditional 3D printing technology (Group T) or 3D printing mirror model technology (Group M) from 2011 to 2017. In total, 146 advanced-age patients (146 hips) with an isolated acetabular fracture (Group T, n = 72; Group M, n = 74) were assessed for a mean follow-up period of 29 months (range, 24-34 months). The primary endpoint was the postoperative Harris hip score (HHS). The secondary endpoints were the operation time, intraoperative blood loss, fluoroscopy screening time, fracture reduction quality, and incidence of postoperative complications at the final follow-up. RESULTS: The HHS, operation time, intraoperative blood loss, fluoroscopy screening time, and incidence of postoperative complications were significantly different between the groups, with Group M showing superior clinical outcomes. CONCLUSION: In patients with an isolated acetabular fracture, 3D printing mirror model technology might lead to more accurate and efficient treatment than traditional 3D printing technology.

Indications and Outcomes of Secondary Hip Procedures After Failed Hip Arthroscopy: A Systematic Review.

PURPOSE: (1) To identify present indications for secondary procedures in patients with failed hip arthroscopy and (2) to assess patient-reported outcomes (PROs) of the secondary procedures, including revision arthroscopy, periacetabular osteotomy (PAO), and total hip arthroplasty (THA). METHODS: Study groups included patients who had a secondary procedure after failed previous hip arthroscopy whereas the control groups were patients who had a primary procedure but did not require a secondary procedure. Indications and procedures at the time of the secondary operation were documented for each study. Average PROs were recorded, and standardized mean difference was calculated to estimate effect size. RESULTS: Eighteen studies reporting on patients undergoing a secondary procedure after a previous hip arthroscopy were included. The 3 main secondary procedure groups were revision hip arthroscopy, secondary PAO, and secondary THA. Regarding the revision arthroscopy group, the most common indications were labral tears, cam deformity, and pincer deformity. In addition, the most common procedures were femoroplasty, acetabuloplasty, capsular release, and labral reconstruction. The most common indications for the secondary PAO and THA groups were dysplasia and osteoarthritis respectively. Five of the revision arthroscopy studies found that revision patients had worse outcomes than the primary arthroscopy group. One PAO study found that the previous arthroscopy group had slightly worse outcomes, and 2 studies found no differences in PROs. Two THA studies reported worse outcomes for the prior arthroscopy group, and 2 studies reported no differences in outcomes. CONCLUSIONS: The most common indications for revision hip arthroscopy were labral tears and femoroacetabular impingement. Patients undergoing a revision hip arthroscopy demonstrated good postoperative outcomes but to an overall lesser extent than their primary counterparts. The secondary PAO and THA groups also had favorable PROs, but the studies were inconclusive in determining superior outcomes between the primary and secondary groups. LEVEL OF EVIDENCE: IV, Systematic review of Level II-IV investigations.

Bloqueo continuo del grupo de nervios pericapsular como analgesia para fractura de columna y pared posterior de acetábulo, reporte de caso y descripción de régimen de infusión para ampliar la cobertura analgésica a la región femoral distal / Continuous pericapsular nerve group blockade as analgesia for fracture of the posterior column and wall of the acetabulum; a case report and description of infusion regimen for extending analgesic effect to the distal femoral area

El uso de bloqueos de nervios para cirugías de cadera tiene beneficios demostrados. El bloqueo del grupo de nervios pericapsular es una técnica nueva que ha demostrado proveer una analgesia más satisfactoria para fracturas y artroplastias de cadera, en comparación con otros bloqueos más comúnmente usados para este tipo de cirugía. Este permite bloquear la inervación de la cápsula anterior a través del nervio obturador y las ramas articulares del femoral y obturador accesorio. Existen escasas publicaciones que describan el uso de catéteres perineurales para proveer analgesia continua utilizando esta técnica. Presentamos un caso de bloqueo continuo para analgesia preoperatoria, en un paciente que sufrió una fractura de columna y pared posterior de acetábulo, por aproximadamente 120 h. Al aumentar la velocidad de infusión se logró agregar analgesia para la región femoral distal. A diferencia de lo descrito previamente, el bloqueo se realizó utilizando un transductor de ultrasonido lineal

The use of peripheral nerve blockade for hip surgeries has proved to be beneficial. The PEricapsular Nerve Group block is a new technique described for hip fracture and hip arthroplasty that has shown to provide better analgesia compared to other peripheral blocks commonly performed for this type of surgery. This technique blocks the obturator nerve and the articular branches of the femoral nerve and the accessory obturator nerve. There are few reports describing continuous analgesia using catheters inserted in the pericapsular nerve group area. We describe a case of continuous nerve block for preoperative analgesia that lasted up to 120 hours in an adult patient with a fracture of the posterior column and wall of the acetabulum. We found that by increasing the infusion rate, analgesia reached the distal femoral area. Unlike the original technique, a high-frequency linear probe was used in this case

Reconstrucción acetabular con el sistema Cup-Cage para discontinuidades pélvicas y defectos acetabulares masivos / Reconstruction for pelvic discontinuity and massive acetabular defects

INTRODUCCIÓN: La reconstrucción acetabular con defectos óseos masivos y discontinuidades pélvicas es un procedimiento quirúrgico complejo que presenta importantes dificultades para el cirujano ortopédico. El objetivo de este estudio es presentar los resultados a corto y medio plazo de la revisión acetabular con el sistema de reconstrucción Cup-Cage en una serie consecutiva de casos. MATERIAL Y MÉTODOS: Retrospectivamente revisamos 22 casos consecutivos de defectos acetabulares masivos (8 Paprosky IIIA y 9 IIIB); 5 discontinuidades pélvicas; 2 fracturas pélvicas durante la implantación de la prótesis primaria, y una seudoartrosis pélvica. Todos fueron revisados con un cotilo de metal trabecular y una caja de reconstrucción tipo Cup-Cage. Se realizó seguimiento clínico y radiográfico de los pacientes para detectar fallos mecánicos o aflojamientos del implante. RESULTADOS: En un tiempo de seguimiento medio de 45,06 meses (12-73 meses) no se objetivó ningún fracaso radiográfico del implante (migración del componente, osteólisis ni rotura de tornillos). Las complicaciones (13,63%) incluyeron una luxación recidivante, una infección y una subluxación recidivante; todos precisaron reintervención quirúrgica. El Merle d'Aubigné-Postel mejoró de 6,91 a 14,36 y la puntuación del rango de movilidad, de 2,91 a 4,36 en promedio de los valores preoperatorios y postoperatorios, respectivamente, así como una mejoría del Harris Hip Score de 30 (16-55) a 72 (40-90) en el último control. CONCLUSIÓN: La reconstrucción acetabular con el sistema Cup-Cage es una alternativa válida para la reconstrucción de pérdidas óseas acetabulares masivas (Paprosky tipo IIIA y IIIB) y discontinuidades pélvicas que ofrece buenos resultados a corto y medio plazo

OBJECTIVE: The acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. MATERIAL AND METHODS: Retrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. RESULTS: With a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d'Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. CONCLUSION: The acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up

Correction of the acetabular index is more crucial than the type of acetabuloplasty in developmental dysplasia.

BACKGROUND: Acetabular remodeling may not be predictable after open reduction in developmental dysplasia of the hip (DDH) in older children. Several acetabuloplasties have been developed, and all are aimed at correcting the dysplastic acetabulum. The goal of this study is to evaluate if the type of pelvic acetabuloplasty and the corrected (postoperative) acetabular index (AI) affect early follow-up femoral head coverage. METHODS: A retrospective review of single-surgeon consecutive acetabuloplasties (Dega or Pemberton) from December 2012 to December 2015 was conducted. The inclusion criteria were a diagnosis of DDH, undergoing simultaneous primary open reduction, and follow-up of at least 18 months. Univariable analysis was based on the type of acetabuloplasty. The correlation between AI and final center edge angle (CEA) was tested. Multiple regression was performed. RESULTS: Of the total 58 hips in 39 patients included, 41 underwent Dega acetabuloplasty, and 17 had Pemberton acetabuloplasty. The median follow-up was 40.50 months (interquartile range 27.25-57). Pemberton acetabuloplasty produced a lower corrected AI, but the difference was not significant in follow-up measurements. Corrected AI was significantly correlated with final CEA (R = - 0.31, P = 0.018). In the multiple regression, only corrected AI was independently associated with final CEA (B = - 0.29, SE = 0.15, P = 0.06), whereas the type of acetabuloplasty, age, and preoperative severity of the dislocation were not. CONCLUSION: The correction obtained during acetabuloplasty affects early follow-up femoral head coverage. Ensuring proper sizing and placement of the grafted bone is probably more important than the type of acetabuloplasty chosen. LEVEL OF EVIDENCE: Level III.