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Online ISSN 1827-1707
98° CONGRESS OF THE PIEDMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (SPLLOT) (Loano, October 19-20, 2001)
ORTHOPEDIC AND TRAUMATOLOGIC SURGERY OF THE HIP
Giacometti Ceroni R., Zagra L.
Background. Since 1979 we performed 157 Wagner's acetabular osteotomies. The original indication was the correction of dysplastic hips in adolescents. By the time, we employed this procedure also in older patients, young adults showing acetabular dysplasia, and finally in patients with some arthritic changes of the joint.
Methods. In comparison with the original surgical technique, we modified the internal fixation of the osteotomy achieved by Kirchner wires introduced through the iliac crest, we studied an osteotomy with a convergent direction in order to displace medially the centre of rotation of the joint and we performed a trans-iliac approach in the last years. The value of the correction is obtained by the evaluation of the CE angle and the faux profile. Complications are described: insufficiency of the abductor muscles, ectopic ossification, bone necrosis, progressive osteoarthrosis, one neurological damage, two infections.
Results. The results are excellent and a complete anatomic restoration of the dysplastic hip can be achieved, but the high rate of complications should be considered, especially in patients with established major preoperative osteoarthrosis whose results can be bad at mid and long term follow-up. Moreover the technique is not able to move enough medially the centre of rotation of the head.
Conclusions. We think that the spherical acetabular osteotomy is a demanding procedure and it should be performed by experienced surgeons. The acetabular dysplasia of the young must be considered the elective indication. In case of osteoarthrosis this operation should be reserved only to patients really motivated and aware of the risks/benefits of the procedure and anyway in hips showing a slight grade of arthritis.