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    Complex Pelvic Osteotomies, Periacetabular Osteotomies

    Complex Pelvic Osteotomies, Periacetabular Osteotomies

    Hip Dysplasia, treated with the help of dedicated surgery, happens when the top part of the thigh bone does not properly connect to the socket part of your hip joint due to a misalignment and a bad shape. It is a common condition in teens and adults, even if there is no history of hip problems in childhood. Treatment options for hip dysplasia include medication and physiotherapy to reduce the pain; however, hip dysplasia surgery, such as Pelvic Osteotomy, provides long-term relief.

     Pelvic Osteotomy

    An osteotomy is an operation in which a bone is cut and reshaped. A pelvic osteotomy is performed by experienced surgeons to reshape a shallow hip socket to fit the curve of the hip joint. This procedure is used to preserve the normal mechanical environment of the hip joint. It is used to stabilise the hip and help in the prevention of premature osteoporosis in patients with Acetabular Dysplasia. Complex Pelvic Osteotomy is performed by making controlled cuts in the pelvic bone to direct the socket. Different types of pelvic osteotomy are performed around the pelvis, depending on the purpose of the operation.

    Pelvic osteotomies can be divided into three main categories, depending on the surgical technique used: Redirective, Reshaping, and Salvage/Augmentation osteotomies.

     Periacetabular Osteotomy

    Hip dysplasia, deformity of the pelvis, causes the acetabulum, the socket in which the hip joint sits, to be deformed. Periacetabular Osteotomy (PAO) corrects this deformity. Hip pain and restricted mobility are common signs of this condition, which can be present from birth but may only become apparent in later life (adolescence or adulthood). For patients with mild dysplasia who do not have advanced osteoarthritis but have a malaligned acetabular joint, partial ankle ossification (PAO) may be considered if non-operative measures are ineffective.

     Preparation for Periacetabular Osteotomy

    The doctor will let the patient know of all the necessary medical examinations to be conducted prior to surgery – including blood tests and, in some cases, X-rays, Magnetic Resonance Imaging (MRI), and CT Scan. These tests also provide the surgeon with the necessary preparation for the operation. Diagnostic images provide an understanding of the hip’s anatomy and enable the physician to gain a better understanding of the condition. These images can be used to develop a surgical plan in relation to the PAO. The doctor will provide the required guidance on when to discontinue food, drink and medication prior to surgery.

     Periacetabular Osteotomy Procedure

    The patient is administered with general anaesthetics just before surgery to ensure that they are asleep during the surgical procedure. In a Periacetabular Osteotomy, surgeons make a series of incisions into the bone to reshape the hip joint’s acetabulum within the pelvis to return the hip joint anatomy to a more normal position. The surgeon inserts screws into the bones to hold the hip joint in this position. As the bone heals, the new bone begins to form over the cut surfaces, anchoring the newly reshaped acetabulum back into the pelvis and re-aligning the hips’ ball and socket. During the procedure, X-rays are used to guide the operation and the surrounding nerves and muscles supporting the hip joint are protected.

     Recovery after Periacetabular Osteotomy

    The recovery period following hip replacement surgery can be a lengthy process. However, the long-term outcomes are typically excellent pain management and long-term functional enhancement. Physical therapy is typically initiated the day just after the surgery and begins with a range of motion exercises. PT normally begins with walking, initially using parallel bars and then using crutches. In addition to the wheelchair, for the initial six weeks, the patient will also be provided with a walker and crutches. During this time, they will be unable to apply any pressure to the operated leg and will only be able to lightly touch the ground with their toes to maintain balance. The patient will then be prepared to receive outpatient physical therapy in addition to a home exercise programme.

    The recovery period for a full hip replacement will be at least six months. The physician will provide guidance on the frequency of re-evaluation. Generally, patients will require re-evaluation after a period of two weeks, six weeks, three months, six months, and one year. Once the hip has fully healed, most individuals are able to resume unrestricted activity—normally, normal daily activities are resumed after three months, and sports are resumed after six months. In cases of dysplasia affecting both hips, a second PAO may be performed approximately six months after the initial surgery.

     Risk & Complications of Pelvic Osteotomy

    Although a Pelvic Osteotomy is the most effective treatment for hip dysplasia, it does come with some risks and complications. Complications of pelvic osteotomy are rare but can include:

    • Nerve and blood vessel injuries.
    • Heterotopic osteogenesis is the growth of bone in an area where it does not normally grow, typically in the soft tissues
    • Intra-articular damage
    • Delayed connection of bone grafts

     Risk and Complications of Periacetabular Osteotomy

    There are always risks associated with any surgery, and the surgeon will always take the necessary steps to ensure the patient’s safety. However, there is always a chance that the patient may have an adverse reaction to the procedure.

    Complications associated with procedures such as Periacetabular osteotomy can include:

    • Shock due to a high blood pressure drop.
    • DVT, or Deep vein thrombosis – a condition that results from the formation of a blood clot in a major vein.
    • Problems with the lungs, such as chest pain, difficulty breathing, or difficulty breathing.
    • Anaesthesia may, in some cases, lead to an allergic reaction.
    • Surgical site infection
    • Problems with urination or urinary retention

    Apollo Hospitals, Karnataka, offers a wide variety of services and expertise to patients seeking Hip dysplasia surgery, and our hip preservation surgeons collaborate with other departments to ensure our patients receive the highest quality of care.

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