Surgical Techniques of Eccentric Rotational Acetabular Osteotomy

INTRODUCTION: This report describes the operative indications and essential techniques of eccentric rotational acetabular osteotomy for hip dysplasia in patients with either pre-osteoarthritis, early arthritis, or in some cases even advanced osteoarthritis of the hip. STEP 1: PATIENT POSITIONING: An accurate lateral decubitus position of the pelvis is important. STEP 2: SKIN INCISION: Make a bikini skin incision and elevate the skin flap. STEP 3: TRANSTROCHANTERIC APPROACH: Make a Y-shaped incision, retract the innominate fossa, and detach the greater trochanter with an oscillating saw. STEP 4: DEEP DISSECTION TO MARK THE OSTEOTOMY LINES: Partially release and divide the rectus femoris, detach the iliacus, and retract the iliopsoas. STEP 5: OSTEOTOMY OF ILIUM AND ISCHIUM: It is essential to use an osteotomy guide to perform an accurate spherical osteotomy. STEP 6: OSTEOTOMY OF THE PUBIC BONE: The osteotomy of the pubic bone is technically demanding. STEP 7: REORIENTATION OF THE ACETABULAR FRAGMENT: The acetabular fragment can be rotated to the intended position as determined by the preoperative planning. STEP 8: REATTACHMENT OF THE GREATER TROCHANTER: Fix the greater trochanter with two AO cancellous screws. STEP 9: POSTOPERATIVE CARE: Walking with a walker and partial weight-bearing begins one day after surgery, and full weight-bearing starts at two months postoperatively. RESULTS: The clinical and radiographic outcomes in the first 126 consecutive patients (132 hips) who had undergone eccentric rotational acetabular osteotomy at our institution were retrospectively assessed. Indications Contraindications Pitfalls & Challenges