The Pelvic Support Osteotomy: A Useful Therapeutic Alternative for Chronically Unstable Hips in Children and Adolescents

TL;DR

Pelvic support osteotomy combined with femoral lengthening effectively treats severe hip instability in children and adolescents, improving gait and leg length discrepancies.

Contribution

Pelvic support osteotomy is presented as a safe and effective alternative to arthrodesis or hip replacement in young patients with complex hip deformities.

Findings

Pelvic support osteotomy combined with femoral lengthening significantly reduces leg length discrepancy and improves gait.

The Trendelenburg sign improved in most patients following the procedure.

Complications occurred in 66% of patients, but the procedure remains a viable treatment option.

Abstract

What are the main findings?

Pelvic support osteotomy combined with femoral lengthening effectively corrects leg length discrepancy and improves gait in children and adolescents with severely damaged hips.

The procedure achieves significant functional improvement, with a marked reduction in Trendelenburg sign and restoration of limb length.

What is the implication of the main finding?

Pelvic support osteotomy is a safe and viable alternative to arthrodesis or total hip arthroplasty in young patients with complex hip deformities.

This technique should be considered in treatment planning for pediatric and adolescent patients where conventional options are limited.

Background/Objectives: The sequelae from conditions affecting the proximal femur may cause instability, pain, leg length discrepancies and abnormal gait. Treatment options include arthrodesis and total hip arthroplasty, but both alternatives have limitations in young patients with severe deformities. Pelvic support osteotomy constitutes a viable option in these cases. The present study analyses the effectiveness and safety of the procedure. Methods: This was a retrospective observational study on patients with an unstable or stiff hip treated with a pelvic support osteotomy. Both the results obtained and the complications that occurred were subjected to a statistical analysis. In addition, a narrative literature review was carried out to elucidate the biomechanical rationale and the results of the technique. Results: This study included a total of 12 patients (8 male and 4 female) with a mean age of 13 years (range: 0–19). All cases were unilateral and the mean follow-up time was 6.9 years (range: 1–10). Preoperative leg length discrepancy was 8 cm (range: 5–10), and all patients presented with a marked Trendelenburg sign. The mean leg lengthening achieved was 8 cm (range: 8–10), following a mean external fixation time of 263 days (range: 180–360), which entails an external fixation index of 32.5 days per centimeter lengthened (range: 25–37). Mean leg length discrepancy fell to 0.9 cm (range: 0–3) and the Trendelenburg sign improved following treatment: it disappeared in three patients (25%), it became mild in seven (58%), and it improved to moderate in two (17%). Eight patients (66%) experienced some sort of complication over the course of treatment. Conclusions: Pelvic support osteotomies, combined with femoral lengthening, are a safe and effective option for managing severely damaged hips in children and adolescents.

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