Management > 18 months

Dislocated Hip

 

Issue

 

Hip has been out for some time

- degree of acetabular dysplasia evident

- less time for remodelling

- increased instability if not addressed

 

Management

 

Open reduction + FDRO / Pelvic Osteotomy 

- usually perform pelvic osteotomy to correct acetabular dysplasia

- reserve FDRO for > 3 years / or if difficult reducing hip

 

Post operative

 

Hip spica for 3/12

- change at 6/52

- CT to confirm enlocated

 

Acetabuloplasty

 

Redirectional / Salter

 

From G. Sciatic notch anteriorly to between ASIS and AIIS

- gigli saw posteriorly

- oscillating saw anteriorly to guide cut

- use apophysis as bone graft

- covers acetabular defect anterolaterally

- stabilised with K wires

 

Disadvantages

 

1.  Provides anterolateral cover

- if combine with FDRO at same time can dislocate the head posteriorly

- i.e. is quite technically difficult to do both femur and acetabulum together

 

2.  Cannot do bilaterally as hinge on pubic symphysis

 

Reshaping / Pemberton or Dega

 

Pemberton

- transiliac into tri-iradiate

 

Dega

- incomplete transiliac

- relay on plasticity of acetabular roof

 

Periacetabular osteotomy

- osteotomy follows acetabular curve

- use curved osteotomes

- insert iliac crest bone graft

- fix with pins

 

Advantage

- simple

- can do bilaterally

 

> 3 years dislocated hip

 

Management

 

Open reduction + Pelvic Osteotomy + DVRO with shortening

- need to add DVRO to obtain reduction

 

Exception

 

> 4 yrs and bilateral

- don't treat

- shown to have poor results

- head is aspherical

- transform painless hips to painful

 

2 - 3 years Acetabular Dysplasia

 

Management

 

Hip enlocated / Acetabular index > 300 and not improving

- pelvic osteotomy