Background: The optimal treatment of severe acetabular dysplasia
with subluxation of the femoral head or the presence of a secondary acetabulum
remains controversial. The purpose of this study was to analyze the extent of
surgical correction and the early clinical results obtained with the Bernese
periacetabular osteotomy for the treatment of severely dysplastic hips in
adolescent and young adult patients.
Methods: Sixteen hips in thirteen patients with an average age of
17.6 years (range, 13.0 to 31.8 years) were classified as having severe
acetabular dysplasia (Group IV or V according to the Severin classification).
Eight hips were classified as subluxated, and eight had a secondary
acetabulum. Preoperatively, all patients had hip pain and sufficient hip joint
congruency on radiographs to be considered candidates for the osteotomy. All
sixteen hips underwent a Bernese periacetabular osteotomy, and six of them
underwent a concomitant proximal femoral osteotomy. Postoperatively, the hips
were assessed radiographically to evaluate correction of deformity, healing of
the osteotomy site, and progression of osteoarthritis. Clinical results and
hip function were measured with the Harris hip score at an average of 4.2
Results: Comparison of preoperative and follow-up radiographs
demonstrated an average improvement of 44.6° (from -20.5° to
24.1°) in the lateral center-edge angle of Wiberg, an average improvement
of 51.0° (from -25.4° to 25.6°) in the anterior center-edge angle
of Lequesne and de Seze, and an average improvement of 25.9° (from
37.3° to 11.4°) in acetabular roof obliquity. The hip center was
translated medially an average of 10 mm (range, 0 to 31 mm). All iliac
osteotomy sites healed. The average Harris hip score improved from 73.4 points
preoperatively to 91.3 points at the time of the latest follow-up. Eleven of
the thirteen patients (fourteen of the sixteen hips) were satisfied with the
result of the surgery, and fourteen hips had a good or excellent clinical
result. Major complications included loss of acetabular fixation, which
required an additional surgical procedure, in one patient and overcorrection
of the acetabulum and an associated ischial nonunion in another patient. Both
patients had a good clinical result at the time of the latest follow-up. There
were no major neurovascular injuries or intra-articular fractures.
Conclusions: The periacetabular osteotomy is an effective technique
for surgical correction of a severely dysplastic acetabulum in adolescents and
young adults. In this series, the early clinical results were very good at an
average of 4.2 years postoperatively; the two major complications did not
compromise the good clinical results.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.