Background
Pelvic support osteotomy can address all the complaints of painful and unstable hips in adolescents and young adults as it eliminates the Trendelenburg gait, equalizes limb-length discrepancy, and stabilizes the hemipelvis. The purpose of this study is to report the clinical and functional outcomes after pelvic support osteotomy used for treatment of painful and unstable hips in a group of patients.
Patients and methods
Forty-four patients (26 female and 18 male) with an average age of 17.2 years complaining of painful and unstable hips resulting from different etiologies and presenting with pain, limping, shortening, and limited range of hip motion were studied. At the end of the follow-up period, which was averaged at 8.2 years, all patients were evaluated for hip pain and limping, hip range motion, lumbar lordosis, limb-length measurement, ambulatory state and pain-free walking distance, the Harris hip score, and overall patient satisfaction.
Results
Hip pain, limping, hip range of motion, lumbar lordosis, ambulatory state, and pain-free walking distance showed improved in all patients. Limb-length equalization was achieved in 38 patients and within 2 cm in five patients with an average residual limb-length discrepancy of 0.8 cm. One patient had 3.5 cm residual shortening. The average amount of bone lengthening achieved was 5.1 cm. The mean radiology consolidation index for callus distraction was 1.4 month/cm, and the mean Ilizarov frame index was 1.7/cm. The Trendelenburg sign became negative in 37 patients and the Harris hip score increased from 48 preoperatively to 83 postoperatively. The following complications were reported: knee stiffness in extension (three); knee stiffness in flexion (one); fracture of the regenerate and loss of valgus correction (three each); and knee sublaxation and premature consolidation (one each).
Conclusion
Pelvic support osteotomy proved to a reliable treatment option among adolescents and young adults with unsuccessfully treated or untreated complex hip disorders presenting with painful unstable hip with shortening and functional ankylosis. A painless and functional hip can be achieved in most of the patients.