Ali AYDIN, Naci EZİRMİK, Fatih KALALI, Pelin AYDIN, Vahit YILDIZ, Ayşenur DOSTİL

The results of Pemberton's pericapsular osteotomy in patients with developmental hip dysplasia

Objective: The aim of this study was to investigate the radiological and clinical outcomes of Pemberton s pericapsular osteotomy in toddlers and preschool children with developmental hip dysplasia. Methods: Ninety-one hips of 86 patients (81 girls, 5 boys) with developmental hip dysplasia who underwent Pemberton s pericapsular osteotomy were included in this study. The mean age of the patients was 34 (range: 18 to 96) months. The mean duration of follow-up was 60 (range: 24 to 158) months. All patients underwent open reduction and Pemberton s pericapsular osteotomy, including 12 hips in which proximal femur osteotomy had been performed earlier. Clinical results were evaluated according to McKay s clinical evaluation criteria, radiological results according to Sever s radiological evaluation criteria, and the presence of avascular necrosis according to Kalamchi-MacEwen s classification criteria. Results: At the final examinations the mean acetabular index was 12.04° (range: 5° to 24°) and the mean Wiberg s center-edge angle was 35.5° (range: 20° to 52°). Clinically, excellent results were obtained in 81 (89.0%) hips, good results were obtained in 2 (2.2%) hips, and fair results in 8 (8.8%) hips. Radiologically, excellent results were obtained in 79 (86.8%) hips, good results in 7 (7.7%) and fair results in 5 (5.5%) hips. Clinically and radiologically no poor results were noted. Type 1 avascular necrosis was detected in 9 (9.9%) hips, Type 2 in 7 (7.7%) hips, and Type 3 in one (1.1%) hip. There were no cases with Type 4 avascular necrosis. Conclusion: Pemberton s pericapsular osteotomy is a safe and effective procedure for the surgical treatment of developmental hip dysplasia in toddlers and preschool children.

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1. Pemberton PA. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 1965;47:65-86.
2. Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am 1994;76: 1777-92.
3. Fleissner PR Jr, Ciccarelli CJ, Eilert RE, Chang FM, Glancy GL. The success of closed reduction in the treatment of complex developmental dislocation of the hip. J Pediatr Orthop 1994;14:631-5.
4. Harris NH, Lloyd-Roberts GC, Gallien R. Acetabular development in congenital dislocation of the hip. With special reference to the indications for acetabuloplasty and pelvic or femoral realignment osteotomy. J Bone Joint Surg Br 1975; 57:46-52.
5. Pemberton PA. Pericapsular osteotomy of the ilium for the treatment of congenitally dislocated hips. Clin Orthop Relat Res 1974;(98):41-54.
6. Millis MB, Kaelin AJ, Schluntz K, Curtis B, Hey L, Hall JE. Spherical acetabular osteotomy for treatment of acetabular dysplasia in adolescents and young adults. J Pediatr Orthop B 1994;3:47-53.
7. Faciszewski T, Kiefer GN, Coleman SS. Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip. J Bone Joint Surg Am 1993;75: 643-9.
8. Tachdjian MO. Pediatric orthopaedics. 2nd ed. Philadelphia: W.B. Saunders; 1990. p. 297-549.
9. Utterback JD, MacEwen GD. Comparison of pelvic osteotomies for the surgical correction of the congenital hip. Clin Orthop Relat Res 1974;(98):104-10.
10. Chapchal G. Indications for the various types of pelvic osteotomy. Clin Orthop Relat Res 1974;(98):111-5.
11. Williamson DM, Glover SD, Benson MK. Congenital dislocation of the hip presenting after the age of three years. A long-term review. J Bone Joint Surg Br 1989;71:745-51.
12. Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am 1984;66:412-20.
13. Tumer Y, Bicimoglu A, Agus H. Surgical treatment of hip dysplasia through the medial approach. Acta Orthop Traumatol Turc 2007;41 Suppl 1:31-6.
14. Aksoy MC. Closed reduction in the treatment of developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2007;41 Suppl 1:25-30.
15. Kerry RM, Simonds GW. Long-term results of late nonoperative reduction of developmental dysplasia of the hip. J Bone Joint Surg Br 1998;80:78-82.
16. Kershaw CJ, Ware HE, Pattinson R, Fixsen JA. Revision of failed open reduction of congenital dislocation of the hip. J Bone Joint Surg Br 1993;75:744-9.
17. Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg Am 1986;68:829-46.
18. Karakurt L, Yilmaz E, Incesu M, Belhan O, Serin E. Early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years. Acta Orthop Traumatol Turc 2004;38:8-15.
19. Abel MF, Sutherland DH, Wenger DR, Mubarak SJ. Evaluation of CT scans 3-D reformatted images for quantitative assessment of the hip. J Pediatr Orthop 1994;14:48-53.
20. Weinstein SL. Congenital hip dislocation. Long-range problems, residual signs, and symptoms after successful treatment. Clin Orthop Relat Res 1992;(281):69-74.
21. Kessler JI, Stevens PM, Smith JT, Carroll KL. Use of allografts in Pemberton osteotomies. J Pediatr Orthop 2001;21: 468-73.
22. Gordon JE, Capelli AM, Strecker WB, Delgado ED, Schoenecker PL. Pemberton pelvic osteotomy and varus rotational osteotomy in the treatment of acetabular dysplasia in patients who have static encephalopathy. J Bone Joint Surg Am 1996;78:1863-71.
23. Shea KG, Coleman SS, Carroll K, Stevens P, Van Boerum DH. Pemberton pericapsular osteotomy to treat a dysplastic hip in cerebral palsy. J Bone Joint Surg Am 1997;79:1342-51.
24. Vedantam R, Capelli AM, Schoenecker PL. Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children. J Pediatr Orthop 1998;18:254-8.
25. Wada A, Fujii T, Takamura K, Yanagida H, Taketa M, Nakamura T. Pemberton osteotomy for developmental dysplasia of the hip in older children. J Pediatr Orthop 2003;23: 508-13.
26. Szepesi K, Rigó J, Bíró B, Fazekas K, Póti L. Pembertons pericapsular osteotomy for the treatment of acetabular dysplasia. J Pediatr Orthop B 1996;5:252-8.
27. Hamzao¤lu A, Esenkaya , Durmaz H, Aflk M, Artamur A. Operative treatment of congenital hip dislocation in older ages with ''open reduction, shortening, derotation, varisation and Pemberton acetabuloplasty." [Article in Turkish] Acta Orthop Traumatol Turc 1990; 24:9-12.
28. Zorer G, Bagatur AE. Single-stage bilateral Pembertons pericapsular osteotomy in bilateral developmental dysplasia of the hip. [Article in Turkish] Acta Orthop Traumatol Turc 2002;36:288-94.
29. McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res 1974;(98):124-32.
30. Hellinger J, Schmidt H. The pericapsular osteotomy of the os ilium in the treatment of flat acetabula. Arch Orthop Trauma Surg 1982;101:53-7.