Triple pelvic osteotomy in complex hip dysplasia seen in neuromuscular and teratologic conditions.

BACKGROUND: The site of acetabular deficiency in hip dysplasia associated with neuromuscular or teratologic conditions is described as posterolateral or global unlike the anterosuperior location in developmental dysplasia of the hip. The triple pelvic osteotomy is a redirectional osteotomy that provides complete control over acetabular fragment placement and can be used to optimize coverage in complex hip dysplasia in skeletally immature hips in which other pelvic osteotomies are ineffective, incomplete, or counterproductive.

METHODS: Thirty-one hips in 26 patients (11 females and 15 males) that had complex hip dysplasia associated with neuromuscular or teratologic conditions were treated with triple pelvic osteotomies. The patients were divided into 2 groups: spastic and nonspastic. Nine of the 15 spastic patients were nonambulatory whereas 1 of the 11 nonspastic patients was nonambulatory. The average age of the patient was 9.6 years and time since surgery was 3 years. Preoperative and postoperative migration index, lateral center-edge angles, and changes in Shenton's line were noted. Computed tomography scans were also compared when available. The surgical technique is described.

RESULTS: The average preoperative lateral center-edge angles and migration index were 1.1 and 42.8 and postoperatively were 39 and 3.7. There was 1 nonunion of the pubic ramus with sciatic nerve palsy. Two patients continued to have persistent hip subluxation.

CONCLUSIONS: We conclude that triple pelvic osteotomy provides adequate mobility of the acetabular fragment to optimize coverage and improve stability in skeletally immature individuals with complex hip dysplasia associated with neuromuscular and teratologic conditions.

LEVEL OF EVIDENCE: Level IV, therapeutic study.