L’ostéotomie périacétabulaire (OPA) est une option chirurgicale pour la correction de la dysplasie acétabulaire et la prévention de la coxarthrose secondaire. Le but de ce travail était d’évaluer nos résultats à moyen terme en précisant indications et complications potentielles ainsi que de décrire nos évolutions techniques.

L’étude comportait 33 hanches dysplasiques (28 patients) traitées par OPA et évaluées au recul moyen de 12 ans (deux à 19 ans). L’âge moyen était de 32 ans (18–47 ans). Le bilan radiologique préopératoire comportait une coxométrie et des clichés de recentrage permettant de classer la dysplasie en moyenne, sévère ou extrême.

Les valeurs de la coxométrie étaient en préopératoire : 23,2°(3° à 40°) pour l’angle d’inclinaison du toit (HTE), 7,6° (−14° à 22°) pour l’angle de couverture externe de Wiberg (VCE), 11,3° (−26° à 32°) pour l’angle VCA de couverture antérieure de Lequesne (VCA). En postopératoire les valeurs moyennes étaient les suivantes : 134,5°(121 à 150°) pour l’angle cervicodiaphysaire, 9,5° (−9° à 20°) pour l’angle HTE ; 31,7° (14° à 60°) pour l’angle VCE ; 31,7° (10° à 48°) pour l’angle VCA. Six patients ont nécessité une arthroplastie totale de hanche au délai moyen de quatre ans. La survie était de 73,8±9 % à 12 ans.

Cette étude confirme la place de l’OPA au sein des traitements chirurgicaux conservateurs de la dysplasie acétabulaire. Des modifications originales ont été apportées notamment : accès intrapelvien unique et OPA réalisée aux deux tiers dans les dysplasies sévères et extrêmes. La meilleure indication nous paraît être le sujet de moins de 30 ans présentant une dysplasie moyenne ou sévère, sans dérangement intra-articulaire ou arthrose même débutante.

Acetabular dysplasia is a recognized cause of early onset degenerative hip disease. With the widespread use of arthroplasty, the role for conservative treatment has become a controversial issue. Periacetabular osteotomy (PAO) as proposed by Ganz has several advantages, but remains a technically difficult procedure. The purpose of this work was to assess our mid-term results considering indications and potential complications and to describe changes in our technique.

This study included 33 dysplasic hips in 24 women and four men, treated by PAO. Mean age was 32 years (range 18–47). Mean follow-up was 12 years (range 2–19). The radiographic work-up included an anteroposterior view of the pelvis and anterior and Lequesne oblique views of the hip joint. The cephalocervicodiaphyseal (CC’D), lateral cover (VCE), anterior cover (VCA), and acetabular roof horizontality (HTE) angles and noted whether osteoarthritis was present or not. Hips were classified with the Hip Study Group system as moderate dysplasia (VCE and VCA 25° to 21°), severe dysplasia (20° to 5°) and extreme dysplasia (less than 5°). The complete work-up included an assessment of joint congruency with recentered films in addition to the surgical lateral view of the hip in order to determine a new index called S/FH (S: acetabular surface, FH: half of the femoral head surface). ArthroCT and MRI were performed in patients with signs of osteoarthritis. The original technique included three cuts (ilio-ischiatic, iliopubic, and iliac) close to the acetabulum using a triple access: infracoxofemoral, intrapelvic, and extrapelvic. The first change in the technique was an osteotomy of the anterosuperior iliac spine and an oblique iliac cut farther from the acetabulum.

Preoperatively, average angle measurements were as follows: 135° (121 to 150°) for CC’D, 23.2° (3° to 40°) for HTE, 7.6° (−14° to 22°) for VCE, 11.3° (−26° to 32°) for VCA. Postoperatively, the values were as follows: 134.5° (121° to 150°) for CC’D, 9.5° (−9° to 20°) for HTE, 31.7° (14° to 60°) for VCE and 31.7° (10° to 48°) for VCA. An intertrochanteric osteotomy was also performed in one patient. The mean Postel–Merle–d’Aubigné score improved from 7.5 points (range 5.6–11) preoperatively to 14.9 (range 8.1–18). At last follow-up, there was no sign of osetoarthritic degradation in 17 patients (51.5%). Seven patients required total hip arthroplasty at mean four years (two to nine years), including one for aseptic acetabular necrosis. Survival was 73.8±9 % at 12 years.

This study confirmed the importance of PAO as part of the therapeutic armamentarium for conservative treatment of acetabular dyplasia. Several changes were made in the original technique: the three cuts were all done via the intrapelvic access; for severe and extreme dysplasia, a two thirds PAO was performed. At the present time, the best indication appears to be young subjects (aged less than 30 years) with moderate to severe dysplasia, with no sign (even minimal) of intra-articular disorder or osteoarthritis.