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Survival of Birmingham Interlocking Pelvic Osteotomy
Dylan JewellCallum McBryde
John O’Hara
The Royal Orthopaedic Hospital Birmingham UK
Dysplastic Hips
The Problem
• What would you expect?
Hip Alignment~Tyre Alignment
• Normal alignment = 40,000 miles• Out of alignment = 15,000 miles• Realigned = ?30,0000 miles• If not….
Indications for surgery
• Hip dysplasia• Centre-Edge-Angle < 30°• Adult Acetabular Index >10°• Incorrect acetabular version• Interruption of the lateral Iliofemoral line
Socket - Radiological Aims• Adult acetabular index <10° • Acetabular anteversion
– Apical = 0°– Deep socket = 20° – Transverse ligament plane ~ 20°
Radiological Aims
Femur
Sourcil/weightbearing zone almost horizontal
Greater trochanter level with centre of femoral head
Round Head• Anteversion= 20°
Bone Cuts
Planning the Bone Cuts
Rotate the
X-ray !
20deg LR
2020°
A
BC
Fixator/Screw Positions
• Reflect bone cuts
Screw 1
Inserted
In IR 10 deg:
Moves to
vertical
12
CBA
==Physiological acetabular anteversion!!!
Alignment verification (all post-op patients seen January 1991-97)
Physiological apical and deep socket anteversion
Operative Details
• Ischium [lateral pos] as per Tonnis• Pubis as vertical as possible
Orthofix Screws• No 1 screw next
to QLP just above (old) TRC,
• Vertical in both planes, then adjust for antiversion
• No 2 position corrects dysplasia angle
112
Iliac Osteotomy
• 12mm saw• Cuts A,B,C,• Reflect
primary correction
A
B C
12
A
C
CB
BA
Fixation
• No 1 screw replaced with 6.5 canc, 4-hole plate upto SIJ
• Iliac crest screw
• Bone graft
Method
• First 100 patients identified• Patient demographics and outcome
determined from questionnaires, hospital notes, telephone interviews.
• Primary Outcome: Survival before Resurfacing/THR required.
• Secondary Outcomes: OHS and UCLA score
Results• 117 TPOs performed by JOH• 3 TPOs without follow-up• Mean follow-up 10 years (0 to 20)
• Mean age 31 (range 7 – 57)• Mean Acetabular Index pre-op 23• Mean Acetabular Index post-op 2• 37 Arthroplasties at mean 8 years
(95% CI 6.8 – 9.3)
Survival Curve
Age
• Our age range was 7 to 57 years• Increasing age was significantly associated
with a worse survival with arthroplasty as the end-point (p=0.02)
<20 yrs: 89%, 18 pts
<25 yrs: 76%, 32 pts
<30 yrs: 67%, 54 pts
Survival for Age of Operation
Years post operation
Survival
Secondary Outcomes
• Oxford Hip Score Median 41 (interquatile range 24-46) • UCLA: 5 (interquatile range 3-7)
UCLA1. Wholly inactive: dependent on others and can not leave house. 2. Mostly inactive: very restricted to minimum activities of daily
living. 3. Sometimes participates in mild activities, such as walking, limited
housework and limited shopping.4. Regularly participates in mild activities. 5. Sometimes participates in moderate activities such as swimming
or could do unlimited housework or shopping.6. Regularly participates in moderate activities. 7. Regularly participates in active events such as bicycling . 8. Regularly participates in active events, such as golf or bowling. 9. Sometimes participates in impact sports such as jogging, tennis,
skiing, acrobatics, ballet, heavy labour or backpacking.10. Regularly participates in impact sports.
Neonatal Septic dislocation
6yrs
13yrs
Now 20yrs FU,Excellent function,
Dance leader on a ship
Complications
• 1 PE(from contralateral leg)• 2 DVT (1 of which in non-operated leg)• 3 Non-union united after bone grafting• 1 temporary sciatic nerve palsy• 2 lateral cutaneous nerve injuries• 1 infection
Conclusions
• The Birmingham Interlocking Pelvic Osteotomy provides a valuable tool to accurately correct acetabular dysplasia,
• Preserving hip function and delaying arthroplasty surgery.
• Does labral pathology matter, once the socket is corrected??