[Enlargement plasty of the acetabulum by vascularized iliac crest cartilage transfer in children]

Abstract

Introduction: Following an experimental study with rabbits published in 1983, the authors report the results of a surgical technique for the enlargement plasty of the acetabulum in children. This study was preceded by an anatomical study of the vascularization of foetal iliac crest epiphysis.

Material: 10 children were operated on at an average of 8 years old. The indications were 5 dysplastic hips (short acetabulum), and 5 Perthes diseases. The results were evaluated by the acetabular index of the weight-bearing zone, Wilberg center-edge angle and joint congruence. The comparison with the non operated side estimated the growth due to the graft.

Methods: An iliac crest cartilaginous fragment 4 to 5 cm long is harvested from the endopelvic side. This graft is pediculized on the deep circonflex iliac vessels. The hip joint is opened and the labrum is partially resected. The graft is correctly oriented, placed at the periphery of the acetabulum in an intra-articular position and fastened with two trans osseous stitches. The length of the vascular pedicle allows to place the graft without any microanastomosis.

Results: At maximum follow-up (range 3.3 to 8 years), in average values, the coverage Wilberg angle increased of 4 degrees on the non operated side and of 23 degrees on the operated side (increase of 19 degrees due to the graf). The acetabular index decreased of 2 degrees on the non operated side and of 10 degrees on the operated side (decrease of 8 degrees due to the graft). The joint congruence showed that the graft molds itself on the femoral head and ensured harmonius coverage. It seemed that it favoured growth remolding of the femoral head.

Discussion: The results showed the growth pursuit of an iliac crest cartilage vascularized graft placed intra-articularly. This graft increases the acetabulum size by adjusting itself to the femoral head. The hyalin cartilage cells of the graft which are in contact with the femoral head, are likely to transform themselves into articular cartilage cells. This surgical technique seems to have its place with the enlargement techniques of the acetabulum as long as remolding of the head and acetabulum is required.