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  • Title: Periacetabular osteotomy for painful non-paralytic dysplastic hip joints in adults affected by poliomyelitis.
    Author: Lin TP, Ko JY, Chen SH, Wu RW, Wong T, Chou WY.
    Journal: Chang Gung Med J; 2007; 30(6):504-12. PubMed ID: 18350733.
    Abstract:
    BACKGROUND: Few researchers have discussed hip joint dysplasia in adults affected by poliomyelitis. We retrospectively studied the outcomes of hip joint function in poliomyelitic adults who underwent periacetabular osteotomy for the contralateral painful non-paralytic dysplastic hip joints. METHODS: Eight female patients with the mean age of 35.9 years underwent periacetabular osteotomy from January 1991 through July 2002. The procedure was performed on eight non-paralytic hip joints via a modified Ollier transtrochanteric approach. Harris hip joint scores and radiographs were used to evaluate the hip joint functions. RESULTS: At a mean of 9.0 +/- 3.8 years postoperatively, the modified Harris hip joint scores had improved from 45.6 +/- 12.9 points preoperatively to 75.8 +/- 20.9 points. Radiographically, the degree of osteoarthrosis remained unchanged in seven hip joints and got worse in one. The anterior center-edge (CE) angle increased from 14.0 +/- 17.5 to 30.9 +/- 10.4 degrees. The lateral CE angle increased from -16.0 +/- 11.7 to 18.0 +/- 23.3 degrees. The acetabular index angle improved from 26.0 +/- 6.9 to 11.3 +/- 4.4 degrees. The acetabular head index increased from 36.1 +/- 11.7 to 63.1 +/- 20.7%. With an outcome system combining modified Harris hip joint scores and radiographic severity of osteoarthrosis, six patients had satisfactory results. Coxa valga usually occurred bilaterally with the neck-shaft angle of 159.1 +/- 15.7 degrees for the operated non-paralytic hip joints versus 161.4 +/- 6.7 degrees for the non-operated paralytic hip joints. Complications included osteonecrosis of the rotated acetabular fragment, acetabulofemoral impingement, a defect on the rotated ilium, and non-union of the superior pubic ramus (one hip joint each). CONCLUSIONS: Acetabular dysplasia can be severe in the non-paralytic leg because of coxa valga, leg length discrepancy, and pelvic tilt. Periacetabular osteotomy through a modified Ollier transtrochanteric approach provides extensive correction and relief of symptoms in most painful non-paralytic dysplastic hip joints in adults affected by poliomyelitis.
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