ORIGINAL ARTICLES   

Minerva Ortopedica e Traumatologica 2010 August;61(4):257-65

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: Italian

Bernese School: what have we learnt about the conservative hip surgery?

Governale G., Aprato A., Stucchi A., Alluto C., Testa E., Massè A.

¹ Dipartimento di Ortopedia e Traumatologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino Italia 2 Università degli Studi di Torino, Torino, Italia

Aim. The congenital hip dysplasia, the femoro-acetabular impingement and the slipped capital femoral epiphysis are three common causes of early hip osteoarthritis; Bernese School described for each of them an innovative surgical technique. The purpose of this work was to analyse the first cases treated with prof. Ganz’s techniques and to evaluate the results.
Methods. From 2007, seven Bernese periacetabular osteotomies were performed in seven dysplastic hips (mean age 27 years). The patients were radiographically evaluated before and after surgical treatment and the head-diaphisis angle, the acetabular index, the Lateral-Centre Edge angle (LCE), the cross over sign and the spine sign were calculated. Eight patients affected by femoroacetabular impingement (mean age 26 years) were evaluated radiographically before and after the surgical treatment and the alfa angle, the Wiber’s Lateral Centre Edge angle (LCE), the Anterior Centre Edge angle (ACEA), the acetabular index and the spine sign were calculated. Last group included 10 SCFE in nine patients. The only female patient was nine-year old, while the mean male age was 15.3 years. Preoperative and postoperative Southwick angles and alpha angle were evaluated. Clinical evaluation for the first and second group of patients was performed using Harris Hip Score (HHS) and the Merlè d’Aubignè Score before the surgical treatment. The third group was evaluated with WOMAC test.
Results. Examining the congenital hip dysplasia group, the acetabular index improved of 18° while the Lateral Centre Edge angle of 24°. Only one patient reached the minimum follow-up and his HHS rose from 52 points preoperatively to 78 points postoperatively. In the femoroacetabular impingement group, the postoperative mean alfa angle improved of 12°. The mean Merlè d’Aubignè score rose 4 points while the HHS 22 points. In the SCFE group the mean HHS had an improvement of 44.4 points while the mean Southwick’s angle decreased in lateral view of 38°, and both the pain and the functional outcomes evaluated through the WOMAC test improved. No cases of avascular necrosis of the femoral head were reported.
Conclusion. The present cases showed radiographic and clinical results similar to those reported the in literature for each group of patients. Although the small sample of this work and the absence of statistical evidence, this work suggests that conservative surgical treatment of the hip seems a good alternative to treat these three pathologies even with the restricted indications, the high demanding surgical technique, a long learning curve and a good reproducibility only in highly specialized centre.