Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 12/2010

01-12-2010 | Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities

Authors: Reinhold Ganz, MD, Kevin Horowitz, MD, Michael Leunig, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2010

Login to get access

Abstract

Background

Residual acetabular dysplasia of the hip in most patients can be corrected by periacetabular osteotomy. However, some patients have intraarticular abnormalities causing insufficient coverage, containment or congruency after periacetabular osteotomy, or extraarticular abnormalities that limit either acetabular correction or hip motion. For these patients, we believe an additional proximal femoral osteotomy can improve coverage, containment, congruency and/or motion.

Purposes

We provide algorithms for (1) identifying patients we believe will benefit from proximal femoral osteotomy, (2) selecting the appropriate osteotomy, and (3) choosing the sequence of these osteotomies.

Methods

Anteroposterior, false-profile and functional radiographs and MR can identify most patients we believe will benefit from periacetabular and femoral osteotomies. Recently described techniques, including relative femoral neck lengthening, femoral neck osteotomy and femoral head osteotomy have expanded indications for a combined procedure. Historically performed first, periacetabular osteotomy is now frequently performed following femoral osteotomy.

Results

The rate of intertrochanteric osteotomy performed with periacetabular osteotomy has decreased from approximately 10% in the first 500 surgeries to about 2% currently. Among 151 relative neck lengthenings (23 with PAO), 53 femoral neck osteotomies (4 with PAO) and 14 femoral head osteotomies (11 with PAO), eleven complications occurred including osteonecrosis in two and delayed unions in eight. No complication occurred following a combined procedure.

Conclusion

Although isolated periacetabular osteotomy can provide sufficient coverage, containment and congruency for most patients with residual hip dysplasia, some may benefit from an additional proximal femoral osteotomy. Knowing the appropriate indications, selection, and sequencing of these osteotomies is critical for enhancing patient outcomes.

Level of Evidence

Level V, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Aronson J. Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect. 1986;35:119–128.PubMed
2.
Boos N, Krushell R, Ganz R, Muller ME. Total hip arthroplasty after previous proximal femoral osteotomy. J Bone Joint Surg Br. 1997;79:247–253.CrossRefPubMed
3.
Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am. 2005;87:254–259.CrossRefPubMed
4.
Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am. 2007;89:1417–1423.CrossRefPubMed
5.
Clohisy JC, St John LC, Nunley RM, Schutz AL, Schoenecker PL. Combined periacetabular and femoral osteotomies for severe hip deformities. Clin Orthop Relat Res. 2009;467:2221–2227.CrossRefPubMed
6.
Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.CrossRefPubMed
7.
Ganz R, Huff TW, Leunig M. Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect. 2009;58:241–255.PubMed
8.
Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36.PubMed
9.
Ganz R, MacDonald SJ. Indications and modern techniques of proximal femoral osteotomies in the adult. Sem Arthroplasty. 1997;8:38–50.
10.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed
11.
Haverkamp D, de Jong PT, Marti RK. Intertrochanteric osteotomies do not impair long-term outcome of subsequent cemented total hip arthroplasties. Clin Orthop Relat Res. 2006;444:154–160.CrossRefPubMed
12.
Hersche O, Casillas M, Ganz R. Indications for intertrochanteric osteotomy after periacetabular osteotomy for adult hip dysplasia. Clin Orthop Relat Res. 1998;347:19–26.CrossRefPubMed
13.
Kalhor M, Beck M, Huff TW, Ganz R. Capsular and pericapsular contributions to acetabular and femoral head perfusion. J Bone Joint Surg Am. 2009;91:409–418.CrossRefPubMed
14.
Leunig M, Puloski S, Beck M, Siebenrock K, Ganz R. Proximal femoral osteotomy: Current indications and techniques. Sem Arthroplasty. 2005;16:53–62.CrossRef
15.
Leunig M, Rothenfluh D, Beck M, Nork SE, Gautier E, Kerboull M, Ganz R. Surgical dislocation and periacetabular osteotomy through a posterolateral approach: a cadaveric feasibility study and intial clinical experience. Oper Tech Orthop. 2004;14:49–57.CrossRef
16.
Leunig M, Siebenrock KA, Ganz R. Rationale of periacetabular osteotomy and background work. Instr Course Lect. 2001;50:229–238.PubMed
17.
Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res. 1999;363:21–32.PubMed
18.
Mayo KA, Trumble SJ, Mast JW. Results of periacetabular osteotomy in patients with previous surgery for hip dysplasia. Clin Orthop Relat Res. 1999;363:73–80.CrossRefPubMed
19.
Miller NH, Krishnan SG, Kamaric E, Noble PC. Long-term results of the dial osteotomy in the treatment of high-grade acetabular dysplasia. Clin Orthop Relat Res. 2005;433:115–123.CrossRefPubMed
20.
Millis MB, Kain M, Sierra R, Trousdale R, Taunton MJ, Kim YJ, Rosenfeld SB, Kamath G, Schoenecker P, Clohisy JC. Periacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study. Clin Orthop Relat Res. 2009;467:2228–2234.CrossRefPubMed
21.
Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect. 1996;45:209–226.PubMed
22.
Murphy SB, Millis MB. Periacetabular osteotomy without abductor dissection using direct anterior exposure. Clin Orthop Relat Res. 1999;364:92–98.CrossRefPubMed
23.
Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:93–99.CrossRefPubMed
24.
Ninomiya S, Tagawa H. Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am. 1984;66:430–436.PubMed
25.
Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.CrossRefPubMed
26.
Poss R. Intertrochanteric osteotomy in osteoarthritis of the hip. Instr Course Lect. 1986;35:129–143.PubMed
27.
Rebello G, Spencer S, Millis MB, Kim YJ. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res. 2009;467:724–731.CrossRefPubMed
28.
Santore RF, Turgeon TR, Phillips WF, III, Kantor SR. Pelvic and femoral osteotomy in the treatment of hip disease in the young adult. Instr Course Lect. 2006;55:131–144.PubMed
29.
Schatzker J. The intertrochnateric osteotomy. Berlin: Springer Verlag; 1984.
30.
Siebenrock KA, Leunig M, Ganz R. Periacetabular osteotomy: the Bernese experience. Instr Course Lect. 2001;50:239–245.PubMed
31.
Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.CrossRefPubMed
32.
Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg Am. 1973;55:343–350.PubMed
33.
Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644.CrossRefPubMed
34.
Sutherland DH, Greenfield R. Double innominate osteotomy. J Bone Joint Surg Am. 1977;59:1082–1091.PubMed
35.
Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, NY: Springer; 1987.
36.
Tönnis D, Itoh K, Heinecke A, Behrens K. The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings [in German]. Z Orthop Ihre Grenzgeb. 1984;122:50–61.CrossRefPubMed
37.
Tönnis D, Kasperczyk W. Acetabulum reorientation osteotomies: acetabuloplasty, spherical osteotomy, triple osteotomy of the pelvis. In: Reynolds D, Freeman M, eds. Osteoarthritis in the Young Adult Hip. Edinburgh, Scotland: Churchill Livingstone; 1989:85–119.
38.
Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am. 1995;77:73–85.PubMed
39.
Turgeon TR, Phillips W, Kantor SR, Santore RF. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Clin Orthop Relat Res. 2005;441:188–199.CrossRefPubMed
40.
Wagner H. Femoral osteotomies for congenital hip dislocation. In: Weil UH, ed. Acetabular Dysplasia, Skeletal Dysplasias in Childhood. Vol 2. Berlin, Germany: Springer-Verlag; 1978:85–105.
Metadata
Title
Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities
Authors
Reinhold Ganz, MD
Kevin Horowitz, MD
Michael Leunig, MD
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1489-z

Other articles of this Issue 12/2010

Clinical Orthopaedics and Related Research® 12/2010 Go to the issue

Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Reduced Femoral Component Subsidence with Improved Impaction Grafting at Revision Hip Arthroplasty

In Brief

In Brief: Fractures in Brief: Calcaneal Fractures

Case Report

Case Report: Spinal Anesthesia by Mini-laminotomy for a Patient with Ankylosing Spondylitis who was Difficult to Anesthetize

Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Elevation of the Femur in THA Through a Direct Anterior Approach: Cadaver and Clinical Studies

Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Incidence and Factors Associated with Squeaking in Alumina-on-Alumina THA