What Is a Pelvic Osteotomy for an Acetabular Dysplasia?

The goals of a pelvic osteotomy are to eliminate hip irritability and instability and minimize the chances of a further hip joint degeneration.

A pelvic osteotomy is indicated in various hip disorders such as developmental dysplasia of the hip involving an acetabular dysplasia and a dislocation, avascular necrosis (bone death) such as Legg-Calve-Perthes-Disease and neuromuscular hip instability. A pelvic osteotomy can reduce the load by enhancing the contact area between the femoral head and acetabulum. It also helps to improve the femoral head coverage by correcting the defect in the acetabulum.

An acetabular dysplasia, also called hip dysplasia, is a disorder that occurs when the acetabulum is shallow and does not provide sufficient support to the femoral head causing instability of the hip joint. Over time, this instability causes damage to the labrum (a ring of fibrous cartilage around the edge of the joint surface of a bone) and cartilage lining of the joint, which can result in pain and development of early hip osteoarthritis.

An acetabular dysplasia can be a result of developmental dislocation of the hip that was treated in infancy or childhood. Therefore, children treated for hip dysplasia should be closely followed by a physician until their bones are fully grown. An acetabular dysplasia can exist as a mild issue that can take years to decades for symptoms to develop. Patients who have been diagnosed with an acetabular dysplasia often have a family history of early hip osteoarthritis or hip dysplasia.

• Patients with an acetabular dysplasia present with
• pain in the hip or groin,
• feelings of instability or “giving way” of the hips,
• change in gait and
• hip dislocation.

Symptomatic medical therapy, muscle-strengthening exercises and weight-relieving exercises can be provided until the surgery and can be continued thereafter.

The surgery is performed under general anesthesia.

Pelvic osteotomies can be categorized into three types based on the surgical technique:
Redirectional, reshaping and salvage/augmentation osteotomies.

• Redirectional osteotomies: These alter the orientation of the acetabulum.
• Reshaping osteotomies: These are involved in changing the shape and volume of the acetabulum.
• Salvage or augmentation osteotomies: These aim to improve the coverage of the defective femoral head.

Like any major surgery, there are complications encountered during a pelvic osteotomy such as

• injury to the nerves and blood vessels,
• pain, swelling and bruising,
• bleeding,
• infection,
• damage to the structures forming the joint,
• delayed union between bone grafts and
• heterotopic ossification (formation of the bone in abnormal sites, usually in the soft tissues).