The Pelvic Support Osteotomy: A Useful Therapeutic Alternative for Chronically Unstable Hips in Children and Adolescents

Abstract

BACKGROUND/OBJECTIVES: The sequelae from conditions affecting the proximal femur may cause instability, pain, leg length discrepancies and abnormal gait. Treatment options include arthrodesis and total hip arthroplasty, but both alternatives have limitations in young patients with severe deformities. Pelvic support osteotomy constitutes a viable option in these cases. The present study analyses the effectiveness and safety of the procedure. METHODS: This was a retrospective observational study on patients with an unstable or stiff hip treated with a pelvic support osteotomy. Both the results obtained and the complications that occurred were subjected to a statistical analysis. In addition, a narrative literature review was carried out to elucidate the biomechanical rationale and the results of the technique. RESULTS: This study included a total of 12 patients (8 male and 4 female) with a mean age of 13 years (range: 0-19). All cases were unilateral and the mean follow-up time was 6.9 years (range: 1-10). Preoperative leg length discrepancy was 8 cm (range: 5-10), and all patients presented with a marked Trendelenburg sign. The mean leg lengthening achieved was 8 cm (range: 8-10), following a mean external fixation time of 263 days (range: 180-360), which entails an external fixation index of 32.5 days per centimeter lengthened (range: 25-37). Mean leg length discrepancy fell to 0.9 cm (range: 0-3) and the Trendelenburg sign improved following treatment: it disappeared in three patients (25%), it became mild in seven (58%), and it improved to moderate in two (17%). Eight patients (66%) experienced some sort of complication over the course of treatment. CONCLUSIONS: Pelvic support osteotomies, combined with femoral lengthening, are a safe and effective option for managing severely damaged hips in children and adolescents.