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Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips
Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Orthopaedic Association
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040371/ https://www.ncbi.nlm.nih.gov/pubmed/24900892 http://dx.doi.org/10.4055/cios.2014.6.2.127 |
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author | Naito, Masatoshi Nakamura, Yoshinari |
author_facet | Naito, Masatoshi Nakamura, Yoshinari |
author_sort | Naito, Masatoshi |
collection | PubMed |
description | Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 ± 0.57 m/sec(2) preoperatively to 1.55 ± 0.31 m/sec(2) postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20° could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far. |
format | Online Article Text |
id | pubmed-4040371 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | The Korean Orthopaedic Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-40403712014-06-04 Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips Naito, Masatoshi Nakamura, Yoshinari Clin Orthop Surg Review Article Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 ± 0.57 m/sec(2) preoperatively to 1.55 ± 0.31 m/sec(2) postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20° could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far. The Korean Orthopaedic Association 2014-06 2014-05-16 /pmc/articles/PMC4040371/ /pubmed/24900892 http://dx.doi.org/10.4055/cios.2014.6.2.127 Text en Copyright © 2014 by The Korean Orthopaedic Association http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Article Naito, Masatoshi Nakamura, Yoshinari Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips |
title | Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips |
title_full | Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips |
title_fullStr | Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips |
title_full_unstemmed | Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips |
title_short | Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips |
title_sort | curved periacetabular osteotomy for the treatment of dysplastic hips |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040371/ https://www.ncbi.nlm.nih.gov/pubmed/24900892 http://dx.doi.org/10.4055/cios.2014.6.2.127 |
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