Osteotomía periacetabular de Ganz para el tratamiento de la displasia del desarrollo de la cadera: experiencia inicial y resultados de los primeros 44 casos

• Gerardo Zanotti ^[1] ; Carlos Martín Lucero ^[1] ; Fernando Díaz Dilernia ^[1] ; Pablo Slullitel ^[1] ; Fernando Comba ^[1] ; Francisco Piccaluga ^[1] ; Martín Buttaro ^[1]
  1. [1] Hospital Italiano de Buenos Aires

     Hospital Italiano de Buenos Aires

     Argentina

     
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 86, Nº. 6, 2021, págs. 727-736
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2021.86.6.1286
• Títulos paralelos:
  • Ganz Periacetabular Osteotomy for the Treatment of Developmental Dysplasia of the Hip: Initial Experience and Results From the First 44 Cases
• Enlaces
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• Resumen
  • español

    Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la osteotomía periacetabular bernesa para tratar la displasia del desarrollo de la cadera.

    Materiales y Métodos: Entre mayo de 2011 y mayo de 2020, se realizaron 44 osteotomías periacetabulares bernesas en 44 pacientes (35 mujeres, edad promedio 30 años [rango 23-38]). Todos tenían diagnóstico de displasia de cadera sintomática. El ángulo centro-borde promedio fue de 17° (rango 9°-20°) y el índice acetabular promedio, de 18° (rango 15°-20°). En 22 casos, se evaluaron y repararon los hallazgos intrarticulares por artroscopia en el mismo acto quirúrgico. Se evaluaron la corrección obtenida, la consolidación de la osteotomía y los resultados funcionales al final del seguimiento.

    Resultados: En 22 pacientes, se detectó hipertrofia y rotura del labrum acetabular asociadas a displasia de cadera. Diez pacientes tenían quistes paralabrales. El ángulo centro-borde promedio posoperatorio fue de 32° (rango 27°-35°) y el índice acetabular, de 6° (rango 4°-9°). El tiempo quirúrgico para la osteotomía periacetabular bernesa fue de 130 min, cuando se sumó un procedimiento artroscópico, el tiempo fue de 148 minutos.

    Conclusiones: La osteotomía periacetabular bernesa es técnicamente demandante, pero logra resultados predecibles en pacientes con integridad del cartílago articular y deformidades corregibles. La artroscopia antes de la osteotomía permite evaluar las condiciones del cartílago, diagnosticar y tratar lesiones intrarticulares asociadas con esta enfermedad y decidir si es necesaria la corrección del déficit de cobertura.

  • English

    Objective:To describe the surgical technique, indications, and initial results of the Bernese periacetabular osteotomy (PAO) for the treatment of developmental dysplasia of the hip. Materials and Methods: Between May 2011 and May 2020, 44 PAOs were performed in 44 patients (35 women) with an average age of 30 years (23-38). All patients had a diagnosis of symptomatic hip dysplasia. The average center-edge angle was 17° (9° to 20°) and the average acetabular index was 18° (15° to 20°). In 22 cases, the intra-articular findings were evaluated and repaired by arthroscopy in the same surgical stage. The correction obtained, the consolidation of the osteotomy, and the functional outcomes at the end of the follow-up were evaluated. Results:Hypertrophy and rupture of the acetabular labrum associated with hip dysplasia were evidenced in 22 patients. Paralabral cysts were found in 10 patients in the series. The average postoperative center-edge angle was 32° (27° to 35°) and the acetabular index was 6° (4° to 9°). The surgical time for PAO was 130 minutes; in patients where an arthroscopic procedure was added, the time was 148 minutes. Conclusions: PAO is technically demanding, but has predictable outcomes in patients with articular cartilage integrity and cor-rectable deformities. Arthroscopy before osteotomy allows assessing cartilage conditions, diagnosing and treating intra-articular lesions associated with this pathology, and deciding on the need to correct the soft tissue deficit.

• Referencias bibliográficas
  • Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J...
  • Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification...
  • Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Sibenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop...
  • Ganz R, Klaue K, Vinh TS, Mast JW. The classic: A new periacetabular osteotomy for the treatment of hip dysplasias. Clin Orthop Relat Res...
  • Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res...
  • Garbuz DS, Awwad MA, Duncan CP. Periacetabular osteotomy and total hip arthroplasty in patients older than 40 years. J Arthroplasty 2008;23(7):960-3....
  • Hsieh PH, Huang KC, Lee PC, Chang YH. Comparison of periacetabular osteotomy and total hip replacement in the same patient: a two- to ten-year...
  • Sharifi E, Sharifi H, Morshed S, Bozic K, Diab M. Cost-effectiveness analysis of periacetabular osteotomy. J Bone Joint Surg Am 2008;90(7):1447-56....
  • Teratani T, Naito M, Kiyama T, Maeyama A. Periacetabular osteotomy in patients fifty years of age or older. J Bone Joint Surg Am 2010;92(1)31-41....
  • Fujii M, Nakashima Y, Noguchi Y, Yamamoto T, Mawatari T, Motomura G, et al. Effect of intra-articular lesions on the outcome of periacetabular...
  • Yasunaga Y, Ikuta Y, Kanazawa T, Takahashi K, Hisatome T. The state of the articular cartilage at the time of surgery as an indication for...
  • Jawad MU, Scully SP. In brief: Crowe’s classification: arthroplasty in developmental dysplasia of the hip. Clin Orthop Relat Res 2011;469(1):306-8....
  • Kovalenko B, Bremjit P, Fernando N. Classifications in Brief: Tönnis classification of hip osteoarthritis. Clin Orthop Relat Res 2018;476(8):1680-4....
  • Byrd JW, Pappas JN, Pedley MJ. Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures....
  • Leunig M, Ganz R. Berner periazetabuläre Osteotomie [The Bernese method of periacetabular osteotomy]. Orthopade 1998;27(11):743-50. https://doi.org/10.1007/pl00003460
  • Fitz-Henry J. The ASA classification and peri-operative risk. Ann R Coll Surg Engl 2011;93(3):185-7. https://doi.org/10.1308/rcsann.2011.93.3.185a
  • Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: an update....
  • Marsell R, Einhorn TA. The biology of fracture healing. Injury 2011;42(6):551-5. https://doi.org/10.1016/j.injury.2011.03.031
  • Beck M, Leunig M, Ellis T, Sledge JB, Ganz R. The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat 2003;25(5-6):361-7....
  • Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation...
  • Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center....
  • Pogliacomi F, Stark A, Wallensten R. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years....
  • Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year follow-up of Bernese periacetabular osteotomy. Clin Orthop Relat Res 2008;466(7):1633-44....
  • Trousdale RT, Cabanela ME. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthop Scand 2003;74(2):119-26. https://doi.org/10.1080/00016470310013824
  • Okano K, Enomoto H, Osaki M, Shindo H. Joint congruency as an indication for rotational acetabular osteotomy. Clin Orthop Relat Res 2009;467:894-900....
  • Troelsen A, Elmengaard B, Soballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement....