Periacetabular Osteotomy Through Modified Smith-Peterson for Development Dysplasia of the Hip in Adults

Ling Hanghui; Xu Zhiqing; Zhuang Zhikun; Wu Zhaoke

Abstract：Objective To evaluate early and mid-term effectiveness of periacetabular osteotomy(PAO)through modified Smith-Peterson for development dysplasia of the hip(DDH)in adults.Methods 21 adults with DDH underwent PAO through modified Smith-Peterson at Quanzhou Orthopaedics Hospital between April 2018 and January 2021.There were 1 male(1 hip)and 20 females(20 hips)containing 12 left hips and 9 right hips.The ages ranged from 18 to 44 years with a mean of(32.15±10.81)years.Among them,5 cases(5 hips)were categorized as modified Tönnis stage 0,14 cases(14 hips)as stage I,and 2 cases(2 hips)as stage Ⅱ.Intraoperative blood loss,surgical duration,hospitalization duration,occurrence of complications and pre-and post-operative Harris hip scores were recorded.Imaging assessments included lateral center edge(LCE)angle,acetabular inclination angle(Tönnis angle),extrusion index(EI),and anterior center edge(ACE)measured via X-rays.Results Bleeding volume was(779.52±29.60)mL,operation time was(115.95±4.44)min,the length of hospital stay was(7.29±0.35)days.Follow-up of all patients was(33.73±9.12)months(range 24～48 months).There were no complications such as vascular injury,fracture of posterior column of acetabulum,poor wound healing,infection,deep venous thrombosis of lower extremity.Postoperative numbness of the lateral femoral cutaneous nerve occurred in 2 adults(2 hips)and disappeard postoperatively 3 months without special treatment.At last follow up,Harris hip score was(89.67±3.44),significantly better than preoperative ones(72.67±4.32)(P＜0.05).At 1 year after operation,X-ray films showed that the all osteotomies healed and there was no osteotomy block osteonecrosis.Postoperative LCE angle was(31.67±3.86)°,significantly better than preoperative ones(9.86±3.25)°(P＜0.05).Postoperative Tönnis angle was(6.57±2.44)°,significantly better than preoperative ones(15.05±2.48)°(P＜0.05).Postoperative EI was(11.33±2.96)％,which was significantly better than preoperative ones(29.19±2.89)％(P＜0.05).Postoperative ACE angle was(30.67±3.71)°,which was significantly better than preoperative ones(8.62±3.31)°(P＜0.05).Conclusion If the indications for surgery are strictly controlled and prevention and treatment of common surgical complications are payed attention to,PAO through modified Smith-Peterson for DDH in adults can effectively improve the osseous covering of hip joint and significantly improve hip joint function,providing satisfactory early and mid-term clinical outcome.