Bernese-type triple pelvic osteotomy through a single incision in children over five years: a retrospective study of twenty eight cases

Abstract

Introduction: Bernese-type triple pelvic osteotomy (BTPO) combines periacetabular and triple innominate osteotomy techniques. However, studies that evaluate the clinical and radiographic outcomes of BTPO are scarce. The aim of this study is to report on the clinical and radiographic outcomes of ambulatory children with developmental dysplasia of the hip (DDH) or Legg-Calvé-Perthes disease (LCPD) managed with BTPO that were older than five years of age at the time of surgery.

Materials and methods: We retrospectively reviewed the records of 27 consecutive patients with DDH or LCPD (mean age 7.6 ± 1.8; 28 hips) who were treated with the reported technique. All patients had regular clinical and radiographic follow-up. Post-operatively, changes in the acetabular index (AI) and centre-edge angle of Wiberg (CEA) were measured in all patients. The presence/absence of avascular necrosis of the femoral epiphysis was also noted in patients with DDH. Final radiographic results were evaluated with the Severin and Stulberg classifications. The Harris hip score was used in the functional evaluation of all patients.

Results: In patients with DDH, the mean age at the time of surgery was 7.5 ± 1.8 years and the mean follow-up time was 22.2 ± 10.7 months. Prior to surgery, the mean AI was 37.9° ± 7.6°. At their final follow-up visit, the mean AI and CEA were 10.8° ± 5.4° and 40.9° ± 8.6°, respectively. Moreover, 66.7% of hips (14/21) were graded as Severin type I, and 33.3% (7/21) were graded as type II. The overall AVN rate was 14.3% (3/21). The mean Harris score was 92.1 ± 7.7. In patients with LCPD, the mean age at the time of surgery was 7.9 ± 1.8 years, and the mean follow-up time was 18.4 ± 6.1 months. Prior to surgery, 85.7% of hips were graded as Herring C, and 14.3% were graded as grade B. Prior to surgery, the mean AI and CEA were 19.4° ± 5.3° and 19.1° ± 12.6°, respectively. At the final follow-up visit, the mean AI and CEA were 5.8° ± 3.4° and 50.3° ± 12.0°, respectively, and 57.1% of hips were graded as Stulberg II. The mean Harris score was 94 ± 5.4. Ischial osteotomy non-unions were recorded in three patients (10.7%).

Conclusions: BTPO through a modified anterior Smith-Peterson approach is an alternative treatment for DDH and LCPD in older children who are skeletally immature. It not only provides for a large acetabular correction but also achieves good biomechanical stability.

Keywords: Bernese-type osteotomy; Children; Development dysplasia of the hip; Legg-Perthes disease; Surgical technique; Triple osteotomy.