Surgical Technique: Reconstruction with a Proximal Varus Derotational Osteotomy with Blade Plate Fixation and a Volume-Reducing Pelvic Osteotomy for Neuromuscular Hip Dysplasia

2021 ◽  
pp. 1-15
Author(s):  
Christine Goodbody ◽  
David A Spiegel ◽  
Keith Baldwin
Keyword(s):  
Surgical Technique ◽  
Hip Dysplasia ◽  
Plate Fixation ◽  
Pelvic Osteotomy ◽  
Blade Plate ◽  
Derotational Osteotomy

Biomechanical evaluation of triple pelvic osteotomy with and without additional ventral plate stabilization

2002 ◽  
Vol 15 (03) ◽  
pp. 145-149 ◽  
Author(s):  
G. Hosgood ◽  
A. Staatz ◽  
R. B. Fitch
Keyword(s):  
Hip Dysplasia ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Pelvic Osteotomy ◽  
Osteotomy Site ◽  
Screw Loosening ◽  
Ventral Plate ◽  
Cyclical Loading ◽  
Biomechanical Evaluation

SummaryThe triple pelvic osteotomy (TPO) is commonly performed for immature dogs with hip dysplasia despite screw loosening being a prevalent complication. A technique to diminish the incidence of screw loosening by reducing motion at the ilial osteotomy and reducing implant migration, was evaluated. Standard triple pelvic osteotomies, and triple pelvic osteotomies with additional ventral plate stabilization, were performed and biomechanically evaluated in canine cadaver pelves. Additional ventral plate fixation was found to significantly improve axial bending stiffness of TPOs. In vitro cyclical loading, performed in a manner to approximate post-operative weight-bearing, determined that additional ventral plate fixation significantly decreased the incidence of screw loosening and motion at the osteotomy site.

Double pelvic osteotomy for the treatment of hip dysplasia in young dogs

2010 ◽  
Vol 23 (06) ◽  
pp. 444-452 ◽  
Author(s):  
A. Vezzoni ◽  
S. Boiocchi ◽  
A. B. Vanelli ◽  
V. Bronzo ◽  
L. Vezzoni
Keyword(s):  
Femoral Head ◽  
Surgical Technique ◽  
Hip Dysplasia ◽  
Pelvic Osteotomy ◽  
Acetabular Coverage ◽  
Pull Out ◽  
Before And After ◽  
Joint Congruity ◽  
Norberg Angle

SummaryThe aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani's sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs AR and AS values immediately postoperatively and at the oneand two-month follow-up examinations were significantly lower than the preoperative values (p <0.01). The complications en-countered were mainly represented by implant failure (3.5%), partial plate pull-out (9.4%), and incomplete fracture of the ischial table (7.5%). Changes in PC and NA values obtained immediately after surgery and at the first and second follow-up examinations were significantly greater (p <0.01 both) than values obtained before surgery. Sufficient acetabular ventroversion was achieved to counteract joint subluxation and the modifications of AR and AS. The NA and PC direct postoperative values reflected a significant improvement in the dorsal acetabular coverage. Clinical relevance: Restoration of normal joint congruity (PC from 50 to 72%) and maintenance of the pelvic geometry without pelvic narrowing were the most intriguing features of DPO. The complications observed were greatly reduced when using dedicated DPO plates. Based on our experience, the morbidity after unilateral and bilateral DPO was lower than after TPO because elimination of the ischiatic osteotomy allowed for increased stability of the pelvis. The surgical technique of DPO was a little more demanding than TPO because of the difficulty in handling and rotating the acetabular iliac segment, but this difficulty was offset by elimination of ischial osteotomy.

Force Plate Analysis of Dogs with Bilateral Hip Dysplasia Treated with a Unilateral Triple Pelvic Osteotomy: A Long-term Review of Cases

1998 ◽  
Vol 11 (02) ◽  
pp. 85-93 ◽  
Author(s):  
Joanne R. Cockshutt ◽  
H. Dobson ◽  
C. W. Miller ◽  
D. L. Holmberg ◽  
Connie L. Taves ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Hip Dysplasia ◽  
Weight Bearing ◽  
Force Plate ◽  
Case Series ◽  
Pelvic Osteotomy ◽  
Vertical Force ◽  
Long Term Outcome ◽  
Case Series Study

SummaryA retrospective case series study was done to determine the long-term outcome of operations upon dogs treated for canine hip dysplasia by means of a triple pelvic osteotomy (TPO). Twentyfour dogs with bilateral hip dysplasia, that received a unilateral TPO between January 1988 and June 1995, were re-examined at the Ontario Veterinary College. The assessment included physical, orthopedic and lameness examinations, standard blood work, pelvic radiographs and force plate gait analysis. They were compared to bilaterally dysplastic dogs that had not been treated, and also to normal dogs. Force plate data analysis demonstrated a significant increase in peak vertical force (PVF) and mean vertical force over stance (MVF) in the limb that underwent surgical correction by means of a TPO, when compared to the unoperated hip. It was determined that performing a unilateral TPO on a young dysplastic dog resulted in greater forces and weight bearing being projected through the TPO corrected limb when compared to the unoperated limb.Dogs with bilateral hip dysplasia treated with a unilateral triple pelvic osteotomy (TPO) were assessed by force plate gait analysis, radiographs and orthopedic examination. There was a significant increase in hip Norberg angles over time, although degenerative changes did progress. Limbs that had been operated upon had significantly greater peak and mean ground reaction forces than limbs that had not received an operation.

Evaluation of Sacroiliac Wedge Rotation to Increase Acetabular Ventroversion

1999 ◽  
Vol 12 (04) ◽  
pp. 173-177 ◽  
Author(s):  
R. L. Aper ◽  
M. D. Brown ◽  
M. G. Conzemius
Keyword(s):  
Hip Joint ◽  
Hip Dysplasia ◽  
Clinical Effect ◽  
Pelvic Osteotomy ◽  
Alternative Method ◽  
Angular Measurements ◽  
Si Joint ◽  
In Vivo Effects ◽  
Canine Hip Dysplasia

SummaryTreatment of canine hip dysplasia (CHD) via triple pelvic osteotomy (TPO) is widely accepted as the treatment that best preserves the existing hip joint. TPO, however, has several important disadvantages. In an effort to avoid some of the difficulties associated with TPO an alternative method of creating acetabular ventroversion (AW) was sought. The purpose of this study was to explore the effects of placement of a wedge in the sacroiliac (SI) joint on A W and to compare this to the effect of TPO on A W . On one hemipelvis a 30° pelvic osteotomy plate was used for TPO. The contralateral hemipelvis had a 28° SI wedge inserted into the SI joint. Pre- and postsurgical radiographs of each pelvis were taken and the angular measurements were recorded. On average, the 28° SI wedge resulted in 20.9° of A W, the 30° canine pelvic osteotomy plate resulted in 24.9° A W . Significant differences were not found (p >0.05) between the two techniques. Sacroiliac wedge rotation effectively creates A W and has several theoretical advantages when compared to TPO. The in vivo effects of sacroiliac wedge rotation should be studied in order to evaluate the clinical effect of the technique.Sacroiliac wedge rotation was tested as an alternative method to increase the angle of acetabular ventroversion. This technique effectively rotated the acetabulum and has several theoretical advantages when compared to triple pelvic osteotomy.

Implant Complications in 20 Triple Pelvic Osteotomies

1993 ◽  
Vol 06 (04) ◽  
pp. 202-207 ◽  
Author(s):  
Cindy Fries ◽  
Audrey Remedios
Keyword(s):  
Postoperative Complication ◽  
Hip Dysplasia ◽  
Pelvic Osteotomy ◽  
Implant Failure ◽  
Screw Loosening ◽  
Common Complication ◽  
Implant Complications ◽  
Gait Abnormalities

SummaryIn 12 dogs with hip dysplasia, 20 triple pelvic osteotomies (eight bilateral and four unilateral) were performed. Screw loosening, occurring in six of 12 dogs (seven of 20 osteotomies), was the most common complication after surgery. Implants loosened from the cranial ilium in six hemipelvises (30%) and from both fragments in one hemipelvis, two to six weeks (mean — three) after the operation. Medial acetabular displace-ment caused pelvic narrowing (6 to 9%, mean = 8%) in three of four dogs. Medial ischial displacement decreased pelvic diameter (11 to 21%, mean = 17%) in four of seven osteotomies. All of the dogs with implant failure were treated conservatively with cage rest and in two cases Ehmer slings were used. Although none were lame, gait abnormalities were evident in three of seven dogs on follow-up examinations four to 12 months (mean = six) later.Screw loosening, occurring in seven of 20 hemipelvises, was the most common postoperative complication associated with triple pelvic osteotomy. Fixation failures were managed conservatively. Despite decreased pelvic diameter in four of seven animals, none were lame or showed signs of pelvic obstruction at follow-up examinations four to 12 months later.

scholarly journals Tuber-to-Anterior Process Angle (TAPA): A Cadaveric Study and Surgical Technique for Placing Axial Calcaneal Screws

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0041
Author(s):  
Kristen L. Stupay ◽  
Jorge Briceno ◽  
Brian Velasco ◽  
John Y. Kwon
Keyword(s):  
Surgical Technique ◽  
Guide Wire ◽  
Articular Surface ◽  
Plate Fixation ◽  
Operative Management ◽  
Screw Placement ◽  
Anterior Process ◽  
Starting Point ◽  
K Wires ◽  
Average Angle

Category: Ankle, Hindfoot Introduction/Purpose: Operative management of displaced intra-articular calcaneus fractures frequently involves placement of P: A screws in order to maintain calcaneal length and axial alignment. While plate fixation may still be more commonly utilized, screw-only fixation for the treatment of these fractures has been demonstrated by several authors to be safe and effective. Directing fixation from the tuber into the anterior process can be challenging. Understanding the calcaneal long-axis as it relates to the long-axis of the foot, a measurement we call the Tuber-to-Anterior Process Angle (TAPA), can facilitate the ease and accuracy of guide-wire and cannulated screw placement. The goals of this study are to define the TAPA, and to report a surgical technique which uses this angle to facilitate axial screw placement. Methods: Eight cadaver feet were utilized. A longitudinal pin was placed from the center of the posterior calcaneal tuber to the 2nd metatarsal heads. Next, the calcaneocuboid joint was exposed, and a wedge of cuboid was removed. A calcaneal pin was then placed, exiting at the center of the anterior process. The tips of two small K-wires were impacted into the medial and lateral-most aspects of the articular surface. A true axial view of each specimen was obtained. On these images, a digital line was drawn from the posterior tuber starting point and the central calcaneal pin, representing the calcaneal long-axis. The angle subtended by this line and the long-axis of the foot represents the TAPA. Digital lines were drawn between the posterior tuber starting point and the medial and lateral K-wires, and the range between their subtending angles represents the axial plane tolerance for screw placement within the anterior process. Results: The average TAPA measured 10.9 ± 1.3 degrees (range: 8.4-13.0). The average angle, as measured to the medial extent of the anterior calcaneus, measured 2.8 ± 1.3 degrees (range: 0.4-4.3). The average angle, as measured to the lateral extent of the anterior calcaneus, measured 19.0 ± 2.7 degrees (range: 15.7-22.7). Conclusion: Knowledge of the Tuber-to-Anterior Process Angle (TAPA), found to be 10.9 degrees (± 1.8 degrees) laterally deviated from the long-axis of the foot, simplifies placement of posterior-to-anterior screws in the calcaneus. Understanding this relationship reduces reliance on intraoperative axial fluoroscopy and increases operative efficiency. Furthermore, this knowledge can be applied during other procedures in which axial screw placement is performed, such as with corrective calcaneal osteotomy.

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