Triple vs. periacetabular osteotomies for acetabular reorientation. Comparative study.
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Feb 12, 2017
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Abstract
Backround
The acetabular osteotomies have had, over time, changes in its indication. In recent years returned the boom for these techniques with the work of R.Ganz,. We present a comparative study between the two techniques in terms of their biomechanical results
Method
We evaluated 12 cases with each of the osteotomy in 24 cases by measuring the displacement of the center of rotation of the head lateral and anterior. We also mesure the percentage of femoral head cover lateral and AP, tilt angles and acetabular anteversion. All data were compared with the contralateral hip without pathology
Results
Lateral displacement of +2.9 mm and +2.47 mm, comparing the contralateral hip, was found in the triple osteotomy. In the periacetabular osteotomy we found a lateralization of +7.6 mm and an anterior flexion of + 6.67 mm.
The percentage of femoral head cover (average) with Triple osteotomy was: lateral 89 % and anterior 99.4 %. With the periacetabula osteotomy was 88 % and 80 %
The acetabular orientation angles with Triple were 39.4 degrees of inclination and 27.1 degrees anteversion, with periacetabular osteotomy the acetabular inclination was 45.5 and 23.11 degrees of anteversion
Conclusions
In our hands we found that the preservation of bone bridge between the ilium and ischium restricts rotation to give prior coverage and shifts the cephalic forward rotation , preferring the Triple osteotomy in cases of severe anterior lack of coverage of the femoral head.
The acetabular osteotomies have had, over time, changes in its indication. In recent years returned the boom for these techniques with the work of R.Ganz,. We present a comparative study between the two techniques in terms of their biomechanical results
Method
We evaluated 12 cases with each of the osteotomy in 24 cases by measuring the displacement of the center of rotation of the head lateral and anterior. We also mesure the percentage of femoral head cover lateral and AP, tilt angles and acetabular anteversion. All data were compared with the contralateral hip without pathology
Results
Lateral displacement of +2.9 mm and +2.47 mm, comparing the contralateral hip, was found in the triple osteotomy. In the periacetabular osteotomy we found a lateralization of +7.6 mm and an anterior flexion of + 6.67 mm.
The percentage of femoral head cover (average) with Triple osteotomy was: lateral 89 % and anterior 99.4 %. With the periacetabula osteotomy was 88 % and 80 %
The acetabular orientation angles with Triple were 39.4 degrees of inclination and 27.1 degrees anteversion, with periacetabular osteotomy the acetabular inclination was 45.5 and 23.11 degrees of anteversion
Conclusions
In our hands we found that the preservation of bone bridge between the ilium and ischium restricts rotation to give prior coverage and shifts the cephalic forward rotation , preferring the Triple osteotomy in cases of severe anterior lack of coverage of the femoral head.
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Falcinelli, S., Gómez, H., Garrido, A., & Arrondo, J. I. (2017). Triple vs. periacetabular osteotomies for acetabular reorientation. Comparative study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(1), 28-39. https://doi.org/10.15417/398
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Clinical Research
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References
1. Niethard, F; Fernandez, NR, y Gussbacher, A: La osteotomía pélvica según Chiari en el tratamiento de la displasia-coxoartrosis. Rev Asoc Arg Ortop Traumat;48 (4):523-527;1983.
2. Dunn HK, Smith JT,Coleman SS. Pelvic osteotomy: an alternative to total hip replacement in the young adult.Hip;3:13;1984.
3. Gallinaro P, Massè A. Flexion Osteotomy in the Treatment of Avascular Necrosis of the Hip. Clin Orthop Relat Res;(386):79-84;2001
4. Stulberg, SD, y Salter, RB: The natural course of leg Perthes disease and its relationship to degenerative arthritis of the hip a long-term follow-up study. Orthop Trans, 1: 385-386, 1977.
5. Movin A, Karlsson V. Skeletal projection for diagnostic radiology,1975.
6. Pemberton PA. Pericapsular osteotomy of the ilium for tratament of congenital dislocation of the hip.J Bone Joint Surg Am;47:65-86;1965
7. Zancolli EA, Befaro F, Gómez HA. Displasia y subluxación congénita inveteradas de la cadera. Evaluación radiológica pre e intraoperatoria para la programación quirúrgica. Rev Asoc Argent Ortop Traumatol;49(4):274-285;1984.
8. Mitchell, GP: Chiari medial displacement osteotomy. Clin Orthop, 98: 146-151, 1974.
9. Gómez, H; Garrido, A, y Mufano, R: Evaluación radiológica de la cadera - importancia del perfil real (quirúrgico). Rev Asoc Ortop Traumatol, 54(4): 488, 1989.
10. Sharp IK. Acetabular dysplasia. The acetabular angle. J Bone Joint Surg (Br);43(2):268-272;1961.
11. Hafner F. Radiologic examination in orthopedics methods and techniques,1971.
12. Mubarak SJ, Valencia EG, Venger AR. One-stage correction of the spastic dislocated hip.J Bone Joint Surg; 74: 1347-1357:1992.
13. Gómez, H; Garrido, A, y Mufano, R: Evaluación radiológica de la cadera - importancia del perfil real (quirúrgico). Rev Asoc Ortop Traumatol, 54(4): 488, 1989.
14. Matsuno T, Ichioka Y, Kaneda K. Modified Chiari pelvic osteotomy: a long-term follow-up study. J Bone Joint Surg (Am);74(4):470-8;1992
15. Ryder CT, Crane. Measuring femoral anteversion: the problem and a method. J Bone Joint Surg;35-A:321-328;1953
16. Donaldson SW, Badgley C. lateral view of the pelvis in examination for hip dislocation. J Bone Joint Surg;30A(2):502;1948.
17. Wenger DR, Frick SL, Kim SK. Pre-and postoperative three-dimensional tomography. Analysis of triple innominate osteotomy for hip dysplasia. J Pediatr Orthop;20(1):116-123;2000.
18. Murphy SB, Kijewski PK, Millis MB, et al. Acetabular dysplasia in the adolescent and young adult. Clin Orthop;(261):214-223;1990
19. Teratani T, Naito M, Kiyama T, Maeyama A. Periacetabular Osteotomy in Patients Fifty Years of Age or Older. J Bone Joint Surg (Am);92:31-41;2010-
20. Millis MB, Kain M, Sierra R, Trousdale R, Taunton MJ, Kim YJ, Rosenfeld SB, Kamath G, Schoenecker P, Clohisy JC. Periacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study.Clin Orthop Relat Res;467(9):2228-34;2009
21. Millis MB, Murphy SB. Use of computed tomographic reconstruction in planning osteotomies of the hip. Clin Orthop; (274):154-159;1992.
22. Turgeon TR, Phillips W, Kantor SR, Santore RF. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Clin Orthop Relat Res;441:188-99;2005.
23. Salter RB. Innuminate osteotomy in the treatment of congenital dislocation and subluxation of the hip.J Bone Joint Surg;33: 5-18;1961
24. Kalamchi A. Modified Salter osteotomy. J Bone Joint Surg Am;64(2):183-7;1982.
25. Sutherland DH, Greenfield R. Double innuminate osteotomy. J Bone Joint Surg (Am);59(8):1082-1091;1977.
26. Steel HH. Triple osteotomy of the innominate bone. A procedure to daccomplish coverage of the dislocated or subluxated femoral head in the older pacient. Clin Orthop;(122):116-127;1977.
27. Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg (Am);55(2):343-350;1973.
28. Steel HH, Lee DY, Choi IH, et al. Triple innominate osteotomy for hip stabilisation and transiliac leg lengthening after poliomyelitis. J Bone Joint Surg (Br);75(6):858-864;1993
29. Kotz R, Da Vid T, Helwig U, Uyka D, Wanivenhaus A, Windhager R. Polygonal triple osteotomy of the pelvis. A correction for dysplastic hip joints.Int Orthop;16(4):311-6;1992.
30. Le Coeur P. Correction des defauts d' orientation de l' anque. Rev Chir Orthop;51:211-212;1965.
31. Schramm M, Hohmann D, Radespiel-Troger M, Pitto RP. The Wagner Spherical Osteotomy of the Acetabulum. J Bone Joint Surg Am;85-A:808-814;2003
32. Wagner H. Osteotomies for congenital hip dislocation. Scientific meeting of the hip society;Pág. 45;St. Louis 1976
33. Dega W, Polakowsky l. Surgical tratament of congenital dislocation of the hip in children a one stage procedure.J Bone Joint Surg (Br);920:4;1959
34. Delp, S; Bleck, E; Zajac, F, y Bollini, G: Biomechanical analysis of the Chiari pelvic osteotomy. Clin Orthop, 254: 189-197, 1988.
35. Pemberton PA. Pericapsular osteotomy of the ilium for tratament of congenital dislocation of the hip.J Bone Joint Surg Am;47:65-86;1965
36. Staheli LT. Slotted acetabular augmentation.Pediatr Orthop;1: 321-327;1973
37. Chiari K. Pelvis osteotomy for hip subluxation. J Bone Joint Surg (Br); 52b:174;1970.
38. Chiari, K: Iliac osteotomy in young adults. The Pelvis. 13; 260-277.
39. Chiari, K: Medial displacement osteotomy of the pelvis. Clin Orthop, 98: 55-71, 1974.
40. Colton, CL: Chiari osteotomy for acetabular dysplasia in young subjects. / Bone Jt Surg (B), 54(4): 578-589, 1972
41. Maghilligan PJ. Calculation of the angle of anteversion by means of horizontal lateral roentgenographic. J Bone Joint Surg;38-A:123;1956
42. Migaud, H; Duquennoy, A; Gougeon, F; Fontaine, C, y Pasquier, G: Outcome of Chiari pelvic osteotomy in adults - 90 hips with 2-15 years follow-up. Acta Orthop Scand, 66(2): 127-131,
43. Millis MB, Hall JE. Transiliac lengthening of the lower extremity. A modified innominate osteotomy for the tratment of postural imbalance. J Bone Joint Surg (Am);61(8):1182-1194;1979
44. Mose K. Methods of measuring in Legg-Calve-Perthes disease with special regard to the prognosis. Clin Orthop;(150):103-109;1980.
45. Hiranuma, S; Higuchi, F; Inove, A, y Miyazaki, M: Changes in the interposed capsule after Chiari osteotomy. J Bone Jt Surg (B), 74(3): 463-467, 1992.
46. Hogh J, Macnicol MF. The Chiari pelvic osteotomy. A long-term review of clinical and radiographic results. J Bone Joint Surg (Br);69(3):365-73;1987
47. Koberle, G: Osteotomia Chiari. Acta Ort Lat, 111(2): 191-207, 1976.
48. Lack, W; Windhager, R; Kutscherd, HP, y Engel, A: Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia - indications and long-term results. J Bone Jt Surg (B), 53(2): 229-233, 1991
49. Lord, G; Marotie, H; Blauchard, JP; Guillamon, JC, y Deplus, P: L'osteotomie de Chiari chez 1'adults - Technique y etude bio-mécanique et premiers resultáis. Rev Chir Orthop, 61: 487-506, 1975.
50. Pauwels F. Des affections de la hanche d´origine et de leur treatement par l´osteotomie d´adduction. Rec Chir Orthop;37:22;1951
51. Rejholec, M; Frantisek, S; Rybka, V, y Polpelka, S: Chiari osteotomy of the pelvis: a long-term study. J Pedriatric Orthop, 10( 1): 21 -27, 1990
52. Tonnis D, Azning A, Bloch M, et al. Triple pelvic osteotomy. J Pediatr Orthop;3:54-67;1994.
53. Hopf A. Hip acetabular displacement by double pelvic osteotomy in the treatment of hip joint dysplasia and subluxation in young people and adults.Z Orthop Ihre Grenzgeb;101(4):559-586;1966
54. Zancolli EA. Alternativas de la artroplastía total de cadera. Osteotomías del ilíaco en displasias de adolescentes y adultos jóvenes. XXIII Congreso Argentino de Ortopedia y Traumatología.Resúmenes del Programa Científico. Buenos Aires, 42-43,1986
55. Zancolli, Eduardo A; Gomez, Horacio; Garrido, Anibal; Peirano, Favio; Arrondo, Jose; Lopez, Roberto.Triple osteotomia del iliaco tritangencial en la displasia de cadera: unico abordaje anterior Rev. Asoc. Argent. Ortop. Traumatol;68(4):246-253, dic. 2003.
56. Hsin J, Saluja R, Eilert RE, Wiedel JD. Evaluation of the biomechanics of the hip following a triple osteotomy of the innominate bone.J Bone Joint Surg Am;78(6):855-62;1996.
57. Faciszewski T, Coleman SS, Biddulph G. Triple innominate osteotomy for acetabular dysplasia. J Pediatr Orthop;13(4):426-30;1993.
58. Tschauner C, Sylkin A, Hofmann S, Graf R. Painful nonunion after triple pelvic osteotomy. Report of five cases. J Bone Joint Surg (Br);85(7):953-5;2003
59. Wagner H. Osteotomies for congenital hip dislocation. Scientific meeting of the hip society;Pág. 45;St. Louis 1976
60. Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg (Am);89(7):1417-23;2007.
61. Ganz R, Horowitz K, Leunig M. Algorithm for femoral and periacetabular osteotomies in complex hip deformities. Clin Orthop Relat Res;468(12):3168-80;2010
62. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary. Clin Orthop;(232):26-36;1988.
63. Peters CL, Erickson JA, Hines JL. Early Results of the Bernese Periacetabular Osteotomy: The Learning Curve at an Academic Medical Center. J. Bone Joint Surg. Am;88:1920-1926;2006
64. Thawrani D, Sucato DJ, Podeszwa DA, DeLaRocha A. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents. J Bone Joint Surg Am;92(8):1707-14;2010.
65. Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular Osteotomy for the Treatment of Severe Acetabular Dysplasia. J Bone Joint Surg Am;87:254-259;2005.
66. Laage H. Horizontal lateral roentgenographic of the hip children. A preliminary report. J Bone Joint Surg;35-A:387;1953
67. Herdon, CH, y Heyman, CH: Legg Perthes disease as evaluation of treatment by traction and ischial weight bearine brace. J Bone Jt Surg, 34:25-46, 1952.
68. Heyman CH, Herndon CH.Legg-Perthes disease; a method for the measurement of the roentgenographic result.J Bone Joint Surg Am;32:767-778;1950.
69. Wiberg, C: Studies on displastic acetabula and congenital subluxations of the hip joint: With special reference to the complication of osteoarthritis. Acta Chir Scand, 83 : 29-37, 1939
70. Benson, MKD, y Evans, ACJ: The pelvic osteotomy of Chiari: an anatomical study of the hazards and misleading radiographic appearances. J Bone Jt Surg (B), 58(2): 164-168, 1976.
71. Fernández, D; Isler, B, y Muller, M: Chiari's osteotomy. Clin Orthop, 185: 53-58, 1984
72. Handelsman, JE: The Chiari pelvic sliding osteotomy. Clin Orthop, 11(1): 105-125, 1980
2. Dunn HK, Smith JT,Coleman SS. Pelvic osteotomy: an alternative to total hip replacement in the young adult.Hip;3:13;1984.
3. Gallinaro P, Massè A. Flexion Osteotomy in the Treatment of Avascular Necrosis of the Hip. Clin Orthop Relat Res;(386):79-84;2001
4. Stulberg, SD, y Salter, RB: The natural course of leg Perthes disease and its relationship to degenerative arthritis of the hip a long-term follow-up study. Orthop Trans, 1: 385-386, 1977.
5. Movin A, Karlsson V. Skeletal projection for diagnostic radiology,1975.
6. Pemberton PA. Pericapsular osteotomy of the ilium for tratament of congenital dislocation of the hip.J Bone Joint Surg Am;47:65-86;1965
7. Zancolli EA, Befaro F, Gómez HA. Displasia y subluxación congénita inveteradas de la cadera. Evaluación radiológica pre e intraoperatoria para la programación quirúrgica. Rev Asoc Argent Ortop Traumatol;49(4):274-285;1984.
8. Mitchell, GP: Chiari medial displacement osteotomy. Clin Orthop, 98: 146-151, 1974.
9. Gómez, H; Garrido, A, y Mufano, R: Evaluación radiológica de la cadera - importancia del perfil real (quirúrgico). Rev Asoc Ortop Traumatol, 54(4): 488, 1989.
10. Sharp IK. Acetabular dysplasia. The acetabular angle. J Bone Joint Surg (Br);43(2):268-272;1961.
11. Hafner F. Radiologic examination in orthopedics methods and techniques,1971.
12. Mubarak SJ, Valencia EG, Venger AR. One-stage correction of the spastic dislocated hip.J Bone Joint Surg; 74: 1347-1357:1992.
13. Gómez, H; Garrido, A, y Mufano, R: Evaluación radiológica de la cadera - importancia del perfil real (quirúrgico). Rev Asoc Ortop Traumatol, 54(4): 488, 1989.
14. Matsuno T, Ichioka Y, Kaneda K. Modified Chiari pelvic osteotomy: a long-term follow-up study. J Bone Joint Surg (Am);74(4):470-8;1992
15. Ryder CT, Crane. Measuring femoral anteversion: the problem and a method. J Bone Joint Surg;35-A:321-328;1953
16. Donaldson SW, Badgley C. lateral view of the pelvis in examination for hip dislocation. J Bone Joint Surg;30A(2):502;1948.
17. Wenger DR, Frick SL, Kim SK. Pre-and postoperative three-dimensional tomography. Analysis of triple innominate osteotomy for hip dysplasia. J Pediatr Orthop;20(1):116-123;2000.
18. Murphy SB, Kijewski PK, Millis MB, et al. Acetabular dysplasia in the adolescent and young adult. Clin Orthop;(261):214-223;1990
19. Teratani T, Naito M, Kiyama T, Maeyama A. Periacetabular Osteotomy in Patients Fifty Years of Age or Older. J Bone Joint Surg (Am);92:31-41;2010-
20. Millis MB, Kain M, Sierra R, Trousdale R, Taunton MJ, Kim YJ, Rosenfeld SB, Kamath G, Schoenecker P, Clohisy JC. Periacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study.Clin Orthop Relat Res;467(9):2228-34;2009
21. Millis MB, Murphy SB. Use of computed tomographic reconstruction in planning osteotomies of the hip. Clin Orthop; (274):154-159;1992.
22. Turgeon TR, Phillips W, Kantor SR, Santore RF. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Clin Orthop Relat Res;441:188-99;2005.
23. Salter RB. Innuminate osteotomy in the treatment of congenital dislocation and subluxation of the hip.J Bone Joint Surg;33: 5-18;1961
24. Kalamchi A. Modified Salter osteotomy. J Bone Joint Surg Am;64(2):183-7;1982.
25. Sutherland DH, Greenfield R. Double innuminate osteotomy. J Bone Joint Surg (Am);59(8):1082-1091;1977.
26. Steel HH. Triple osteotomy of the innominate bone. A procedure to daccomplish coverage of the dislocated or subluxated femoral head in the older pacient. Clin Orthop;(122):116-127;1977.
27. Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg (Am);55(2):343-350;1973.
28. Steel HH, Lee DY, Choi IH, et al. Triple innominate osteotomy for hip stabilisation and transiliac leg lengthening after poliomyelitis. J Bone Joint Surg (Br);75(6):858-864;1993
29. Kotz R, Da Vid T, Helwig U, Uyka D, Wanivenhaus A, Windhager R. Polygonal triple osteotomy of the pelvis. A correction for dysplastic hip joints.Int Orthop;16(4):311-6;1992.
30. Le Coeur P. Correction des defauts d' orientation de l' anque. Rev Chir Orthop;51:211-212;1965.
31. Schramm M, Hohmann D, Radespiel-Troger M, Pitto RP. The Wagner Spherical Osteotomy of the Acetabulum. J Bone Joint Surg Am;85-A:808-814;2003
32. Wagner H. Osteotomies for congenital hip dislocation. Scientific meeting of the hip society;Pág. 45;St. Louis 1976
33. Dega W, Polakowsky l. Surgical tratament of congenital dislocation of the hip in children a one stage procedure.J Bone Joint Surg (Br);920:4;1959
34. Delp, S; Bleck, E; Zajac, F, y Bollini, G: Biomechanical analysis of the Chiari pelvic osteotomy. Clin Orthop, 254: 189-197, 1988.
35. Pemberton PA. Pericapsular osteotomy of the ilium for tratament of congenital dislocation of the hip.J Bone Joint Surg Am;47:65-86;1965
36. Staheli LT. Slotted acetabular augmentation.Pediatr Orthop;1: 321-327;1973
37. Chiari K. Pelvis osteotomy for hip subluxation. J Bone Joint Surg (Br); 52b:174;1970.
38. Chiari, K: Iliac osteotomy in young adults. The Pelvis. 13; 260-277.
39. Chiari, K: Medial displacement osteotomy of the pelvis. Clin Orthop, 98: 55-71, 1974.
40. Colton, CL: Chiari osteotomy for acetabular dysplasia in young subjects. / Bone Jt Surg (B), 54(4): 578-589, 1972
41. Maghilligan PJ. Calculation of the angle of anteversion by means of horizontal lateral roentgenographic. J Bone Joint Surg;38-A:123;1956
42. Migaud, H; Duquennoy, A; Gougeon, F; Fontaine, C, y Pasquier, G: Outcome of Chiari pelvic osteotomy in adults - 90 hips with 2-15 years follow-up. Acta Orthop Scand, 66(2): 127-131,
43. Millis MB, Hall JE. Transiliac lengthening of the lower extremity. A modified innominate osteotomy for the tratment of postural imbalance. J Bone Joint Surg (Am);61(8):1182-1194;1979
44. Mose K. Methods of measuring in Legg-Calve-Perthes disease with special regard to the prognosis. Clin Orthop;(150):103-109;1980.
45. Hiranuma, S; Higuchi, F; Inove, A, y Miyazaki, M: Changes in the interposed capsule after Chiari osteotomy. J Bone Jt Surg (B), 74(3): 463-467, 1992.
46. Hogh J, Macnicol MF. The Chiari pelvic osteotomy. A long-term review of clinical and radiographic results. J Bone Joint Surg (Br);69(3):365-73;1987
47. Koberle, G: Osteotomia Chiari. Acta Ort Lat, 111(2): 191-207, 1976.
48. Lack, W; Windhager, R; Kutscherd, HP, y Engel, A: Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia - indications and long-term results. J Bone Jt Surg (B), 53(2): 229-233, 1991
49. Lord, G; Marotie, H; Blauchard, JP; Guillamon, JC, y Deplus, P: L'osteotomie de Chiari chez 1'adults - Technique y etude bio-mécanique et premiers resultáis. Rev Chir Orthop, 61: 487-506, 1975.
50. Pauwels F. Des affections de la hanche d´origine et de leur treatement par l´osteotomie d´adduction. Rec Chir Orthop;37:22;1951
51. Rejholec, M; Frantisek, S; Rybka, V, y Polpelka, S: Chiari osteotomy of the pelvis: a long-term study. J Pedriatric Orthop, 10( 1): 21 -27, 1990
52. Tonnis D, Azning A, Bloch M, et al. Triple pelvic osteotomy. J Pediatr Orthop;3:54-67;1994.
53. Hopf A. Hip acetabular displacement by double pelvic osteotomy in the treatment of hip joint dysplasia and subluxation in young people and adults.Z Orthop Ihre Grenzgeb;101(4):559-586;1966
54. Zancolli EA. Alternativas de la artroplastía total de cadera. Osteotomías del ilíaco en displasias de adolescentes y adultos jóvenes. XXIII Congreso Argentino de Ortopedia y Traumatología.Resúmenes del Programa Científico. Buenos Aires, 42-43,1986
55. Zancolli, Eduardo A; Gomez, Horacio; Garrido, Anibal; Peirano, Favio; Arrondo, Jose; Lopez, Roberto.Triple osteotomia del iliaco tritangencial en la displasia de cadera: unico abordaje anterior Rev. Asoc. Argent. Ortop. Traumatol;68(4):246-253, dic. 2003.
56. Hsin J, Saluja R, Eilert RE, Wiedel JD. Evaluation of the biomechanics of the hip following a triple osteotomy of the innominate bone.J Bone Joint Surg Am;78(6):855-62;1996.
57. Faciszewski T, Coleman SS, Biddulph G. Triple innominate osteotomy for acetabular dysplasia. J Pediatr Orthop;13(4):426-30;1993.
58. Tschauner C, Sylkin A, Hofmann S, Graf R. Painful nonunion after triple pelvic osteotomy. Report of five cases. J Bone Joint Surg (Br);85(7):953-5;2003
59. Wagner H. Osteotomies for congenital hip dislocation. Scientific meeting of the hip society;Pág. 45;St. Louis 1976
60. Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg (Am);89(7):1417-23;2007.
61. Ganz R, Horowitz K, Leunig M. Algorithm for femoral and periacetabular osteotomies in complex hip deformities. Clin Orthop Relat Res;468(12):3168-80;2010
62. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary. Clin Orthop;(232):26-36;1988.
63. Peters CL, Erickson JA, Hines JL. Early Results of the Bernese Periacetabular Osteotomy: The Learning Curve at an Academic Medical Center. J. Bone Joint Surg. Am;88:1920-1926;2006
64. Thawrani D, Sucato DJ, Podeszwa DA, DeLaRocha A. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents. J Bone Joint Surg Am;92(8):1707-14;2010.
65. Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular Osteotomy for the Treatment of Severe Acetabular Dysplasia. J Bone Joint Surg Am;87:254-259;2005.
66. Laage H. Horizontal lateral roentgenographic of the hip children. A preliminary report. J Bone Joint Surg;35-A:387;1953
67. Herdon, CH, y Heyman, CH: Legg Perthes disease as evaluation of treatment by traction and ischial weight bearine brace. J Bone Jt Surg, 34:25-46, 1952.
68. Heyman CH, Herndon CH.Legg-Perthes disease; a method for the measurement of the roentgenographic result.J Bone Joint Surg Am;32:767-778;1950.
69. Wiberg, C: Studies on displastic acetabula and congenital subluxations of the hip joint: With special reference to the complication of osteoarthritis. Acta Chir Scand, 83 : 29-37, 1939
70. Benson, MKD, y Evans, ACJ: The pelvic osteotomy of Chiari: an anatomical study of the hazards and misleading radiographic appearances. J Bone Jt Surg (B), 58(2): 164-168, 1976.
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