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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
HIP UPDATE 2013
Minerva Ortopedica e Traumatologica 2013 February;64(1):41-52
Developmental dysplasia of hip: joint preserving surgery in the adolescent and young adult
Turchetto L. 1, Massè A. 2, Aprato A. 2, Barbuio A. 1, Ganz R. 3 ✉
1 Ospedale di Portogruaro ULSS 10 Veneto Orientale, Portogruaro, Venezia, Italy;
2 AOU San Luigi di Orbassano, School of Medicine, University of Turin, Turin, Italy;
3 University of Bern, Bern, Switzerland
Developmental dysplasia is subsequent to global or local growth retardation, mainly of the acetabulum. There is individual growth retardation as well as influence of adverse mechanical forces which are responsable for the development of hip dysplasia, taking place in fetal life and/or after birth. Hip dysplasia is not an uniform anterolateral insufficiency of coverage of the femoral head but shows a multitude of pure and combined anterior, lateral, and posterior dysplasia.
Overload of the rim generates pressure point loading which leads to rapid degenerative arthritis. It can be successfully treated by reestablishing and maintaining centralised pressure of the femoral head. Correction on the acetabular side improve coverage, load transmission area and stability of the femoral head.
The periacetabular osteotomy is a very powerful technique, offering the ability to correct deformity in all planes. However, just like any surgical technique, the indications and limitations of the technique must be understood. Femoral osteotomies continue to be indicated as an additional correction of excessive valgus and anteversion of the neck and are normally executed at the intertrochanteric or subtrochanteric level. Intraarticular femoral osteotomies are more direct and therefore allow a more powerful correction with no o very little undesired side correction.