Dega osteotomy for the treatment of congenital dysplasia of. Dega osteotomy has gained popularity for the acetabular reconstruction of developmental dysplasia of the hip ddh. Jun 21, 2014 a presentation highlighting the key differences between various acetabular osteotomies. Although much confusion still surrounds the actual procedure of the dega osteotomy, it is one of the most commonly used osteotomies in the. The onestage procedure open reduction, capsulorrhaphy, and innominate osteotomy is preferred by many authors. Corrective osteotomy information for patients what is corrective osteotomy. An osteotomy with a long plantar arm by selecting the fi rst and third slots. The age of the patients at the time of surgery ranged from 25 to 90 mean 48. Reported just a few years after pembertons osteotomy, the dega osteotomy was part of a continuum of incomplete osteotomies that also include the pembersal and the san diego osteotomies. The dega osteotomyacetabuloplasty for clinicians johns. Rehabilitation guidelines for periacetabular osteotomy. The aim of this work is to analyze a group of patients with ddh treated by combined open reduction and dega transiliac osteotomy, evaluate the results and determine the advantages, disadvantages, assess the factors affecting the final outcome of such procedure. In a dega osteotomy pelvic osteotomy a cut is made into the pelvis above the socket of the hip joint. Femoral and dega osteotomies in the treatment of habitual hip dislocation in down syndrome patients is it efficient or not.
The high osteotomy cut of dega procedure for developmental. Institute of orthopedics and sports medicine, 2nd floor, main hospital. Poorly fitting hip bones can cause pain and make it difficult to move. Dega pelvic osteotomy in developmental hip dysplasia surgery sattar alhabeeb. Salter innominate osteotomy and pemberton osteotomy are the most widely used procedures to treat the developmental dysplasia of the hip. The iliac osteotomy described by wiktor dega in poland in 1969 7 is an acetabuloplasty that changes the acetabular configuration and its inclination. Hip dysplasia or ddh is normally diagnosed in babies however it can develop later on. Outcomes of modified dega acetabuloplasty in acetabular. A presentation highlighting the key differences between various acetabular osteotomies. Obrien osteotomy guide designed by todd obrien, dpm designed for chevron bunionectomies the guide clamps directly onto bone while helping to retract the ehl tendon. Hip osteotomy is done when the hip bones do not fit together well. A hip osteotomy is a surgery to cut, reshape, and reposition the bones of the pelvis or legs. Dega, working in poznan, poland, described an incomplete iliac osteotomy in 1969.
Pelvic reorientation osteotomies and acetabuloplasties in children. Jul 22, 2016 pericapsular osteotomies of pemberton and dega tim schrader w. The effect of dega acetabuloplasty and salter innominate. Combined open reduction and dega transiliac osteotomy for. It also preserves the entire cortex of the sciatic notch, forming a hinge to provide more anterior and lateral femoral head coverage. It is only for wear and tear osteoarthritis, not for inflammatory arthritis such as rheumatoid arthritis. At end of followup, all hips were painfree and classified as wicart a, and all. Article pdf available in journal of children s orthopaedics 123. Timothy ward definition the pemberton7 fig 1 and dega1, 2 fig 2 osteotomies are performed for acetabular dysplasia that is either part of a developmental disorder or an acquired disorder due to muscle imbalance in neuromuscular conditions. Reflect triceps tendon, protecting the ulnar and radial nerves. In older children, a pelvic osteotomy is needed to achieve a stable concentric reduction. A surgical cut is made in the pelvis, above the socket.
Dega osteotomy for the treatment of developmental dysplasia of the. Pelvic osteotomies for developmental dysplasia of the hip. However, it then stops about 1 cm from the sciatic notch on the lateral surface. The exciting aspect, however, about the dega osteotomy is its versatility in providing femoral head coverage in any. Over a long period of time, the improper fit can lead to problems like arthritis.
It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is done during the same operative time as any work on the femur and or muscles around the hip. Rehabilitation guidelines for periacetabular osteotomy pao. One advantage of the bigger procedure is that all the elements of hip dysplasia are corrected surgically so that the time in the cast is actually less than waiting for natural growth to help restore the joint to normal. Dega osteotomy for the correction of acetabular dysplasia of the hip. Osteotomies around hip by dr rohit kumar linkedin slideshare. The aim of this study was to evaluate the short to middleterm clinical and radiographic results of the management of ddh. Prerequisite dega and pemberton osteotomies require that the femoral head can be completely relocated, the joint surfaces be adequately congruent, the joint have good mobility, and the triradiate cartilage be open.
The dega osteotomy is an incomplete transiliac osteotomy and takes advantage of the inherent flexibility of the posterior column of bone in the pelvises of young children to reshape the acetabulum. The surgeon bends part of the pelvic bone down to make the socket into more of a cup. Active, expires 20280324 application number us11230,072 other versions us20070083214a1 en. The dega osteotomy is a versatile procedure that is widely used to treat neuromuscular hip dysplasia. Pdf dega osteotomy for the correction of acetabular. Conclusion dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in. Us7582091b2 us11230,072 us23007205a us7582091b2 us 7582091 b2 us7582091 b2 us 7582091b2 us 23007205 a us23007205 a us 23007205a us 7582091 b2 us7582091 b2 us 7582091b2 authority us united states prior art keywords paddle osteotomy guide leg guide outrigger prior art date 20050919 legal status the legal status is an assumption and is not a. Following completion of the osteotomy, the clamp is removed, the metatarsal head transposed laterally and fi xation achieved according to the surgeons. The full text of this article is available in pdf format. Please select ok if you would like to o with this request anyway. The pemberton osteotomy extends directly to the triradiate cartilage 16.
Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Makes informed decision to proceed with operative treatment. Dega osteotomy for the management of developmental dysplasia of the hip in children aged years results of 58 consecutive osteotomies after 25 years of followup. An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. The hip joint is a ball and socket joint that not only allows flexion and extension, but also rotation of the thigh and leg fig 1. Appropriately interprets basic imaging studies and recognizes fracture patterns. Aug 28, 2019 dega osteotomy for the management of developmental dysplasia of the hip in children aged years results of 58 consecutive osteotomies after 25 years of followup.
The dega acetabuloplasty reduces the diameter of the acetabulum and improves overall femoral head coverage anterior, lateral, and posterior. Pelvic reorientation osteotomies and acetabuloplasties in. Mar 09, 2018 a safe,efficient and versatile pelvic osteotomy in ddh. The dega osteotomy hinges the acetabulum the socket down over the head of the femur thigh bone. Answers to your questions about developmental dysplasia of the hip ddh, also known as hip dysplasia, in humans. Placing apex of template angle to be corrected medially with the superior margin perpendicular to the humeral shaft. Recognize vascular, nerve or other associated injuries. Femoral osteotomy, when planned, was via a lateral incision on the thigh. It is also used to correct a coxa vara, genu valgum, and genu varum. Outcomes of modified dega acetabuloplasty in acetabular dysplasia. Dega osteotomy for the correction of acetabular dysplasia of. A highlevel dega osteotomy combining the typical dega procedure with an age limit of under 6 years and the higher pelvic cut height of the salter osteotomy for walking ddh patients aged 6 or younger was advocated in our department.
Head of femur is replaced on femoral neck and three threaded steinmann pins are used for fixation of shaft, head, and neck of femur. Lateral closing wedge osteotomy in metaphyseal region superior to olecranon fossa. Osteotomy line on upper end of femoral neck is made for excision of trapezoid segment. The entire buttock area must be left free to facilitate the surgical approach and the hip.
Radiographic parameters were measured at the preoperative, immediate postoperative, and final followup time points. The dega osteotomy is a particular procedure that has been very successful in treating the hips of children with cerebral palsy. Corrective osteotomy information for patients what is. Patients in walking age are indicated for pelvic osteotomy to correct the dysplastic acetabulum. An osteotomy is a surgical procedure that involves dividing a bone at a selected site to create an artificial fracture, and fixing it in a corrected position. In the dega acetabuloplasty, the osteotomy line is incomplete. To be included in the study group, each patient had to have complete clinical documentation of the range of motion, presence or absence of a limp, limblength discrepancy, hip pain, and limitation. There is a paucity of the english language literature on its use in acetabular dysplasia seen in developmental dysplasia of the hip ddh. A hip osteotomy is a surgery to cut, reshape, and reposition the bones of. Dega pelvic osteotomy in developmental hip dysplasia surgery. The femur is cut just proximal to the lateral condyle beginning. Jun 23, 2015 the dega osteotomy alone was performed in seven hips 12 %, the dega osteotomy with femoral shortening fs was performed in two hips 3. They will probably be combined with a procedure to relax tight muscles around the hips. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.
Pdf purpose developmental dysplasia of the hip ddh after walking age is difficult to treat. Dega osteotomy for the treatment of congenital dysplasia. May 31, 2016 dega osteotomy has gained popularity for the acetabular reconstruction of developmental dysplasia of the hip ddh. Pelvic osteotomy, acetabuloplasty, periacetabular osteotomy, salter, dega, pemberton. Dega osteotomy for the management of developmental dysplasia. An osteotomy with a long dorsal arm by selecting the second slot marked 10 and the fourth slot, or 3.
Modified dega osteotomy showed good initial radiological results and the potential for use in treating developmental dysplasia of the hip. As for the pemberton, the dega osteotomy starts at the aiis and extends posteriorly following the insertion of the capsule. Stepcut osteotomy derosa and graziano posterior approach. Combined pelvic and femoral reconstruction in children. The dega osteotomyacetabuloplasty for clinicians overview the dega osteotomy as originally described provides anterior and lateral coverage for patients with developmental dysplasia of the hip by preserving the inner table of the pelvis posterior to the iliopectineal line and the entire cortex of the sciatic notch. Grudziak js, labaziewicz l, kruczynski j, nowakowski a, wieruszkozlowska m, schwartz r.
The dega osteotomy preserves the inner table of the pelvis posterior to the iliopectineal line. Check out our entire database and interactive tools to learn more about conditions, procedures, and gain insight into your health risks. Miller f, girardi h, ponzio r, lipton g, klaumann m, dabney k. Sutures out, dc ted hose when effusion is resolved brace 090 degrees. The surgical management of neglected developmental dysplasia of the hip ddh in walking children has always been a challenge to orthopedic surgeons. Pdf femoral and dega osteotomies in the treatment of.
Rehabilitation guidelines for periacetabular osteotomy pao of the hip the hip joint is composed of the femur the thigh bone and the acetabulum the socket formed by the three pelvic bones. Treatment of developmental dysplasia of the hip ddh is based on concentric reducibility of the femoral head, patient age and the status of triradiate cartilage. The cut is opened allowing the femur to be placed in the desired degree of alignment. This paper describes the technique of the main osteotomies used in children, with. In a dega osteotomy, a cut is made in the pelvis above the pelvic socket. This is a more common procedure in children older than 18 months. Knee osteotomy miranda nsw joint replacement surgery. The new position of the socket is held with a small block of bone. The osteotomy is then held in place with a strong surgical plate and screws until the bone heals in this new position. Fig 2 dega osteotomy depicted on bone model viewed from anteriorly a, from inside the pelvis medially b, and from outside the pelvis laterally c. Dega refers to the orthopedist who first described the technique and osteotomy refers to the fact that the bone of the socket is cut. Radiographic parameters were measured at the preoperative, immediate postoperative, and final followup.
Reconstruction of the dysplastic spastic hip with periilial pelvic osteotomy and femoral osteotomy followed by immediate mobilization. Dega osteotomy for the management of developmental dysplasia of. Operative procedures include open reduction, closed reduction, kalamchi modification osteotomy, bowen osteotomy, double osteotomies, periacetabular osteotomies, pemberton osteotomy, dega osteotomy, macewen and shands osteotomy, varus osteotomy with rigid internal fixation, valgus osteotomy with rigid internal fixation, femoral shortening and. Figure 3 the greatest advantage of an osteotomy is in preserving ones own knee joint as opposed to replacing the knee joint with a prosthetic device knee replacement or arthroplasty. It is used to correct axial and torsion deformities and length discrepancies in the lower limbs.
Distal femoral osteotomy rehab protocol description of procedure. This allows an adequate acetabular coverage for anterior, lateral and mainly posterior deficiencies. Salter innominate osteotomy and pemberton osteotomy are the most widely used procedures to treat the developmental. The dega osteotomy alone was performed in seven hips 12 %, the dega osteotomy with femoral shortening fs was performed in two hips 3. In 1918, ludloff 11 described an oblique osteotomy of the first metatarsal. Aug 01, 2018 the iliac osteotomy described by wiktor dega in poland in 1969 7 is an acetabuloplasty that changes the acetabular configuration and its inclination. This osteotomy technique has, however, rarely been assessed in this particular.
By turning down the top part of the flat hip socket, a more cuplike shape is created which can fit around the ball of the hip to help contain it in the correct position. Patients less than 6 years old using two of the most commonly used osteotomies. Ludloff osteotomy seems to be the most favorable osteotomy for correction of more severe hallux valgus deformity. Gallandkirby high tibial osteotomy postsurgical rehabilitation protocol postop days 1 14 dressing. According to cpt assistant, code 27146 is intended to be reported only one time per bone, regardless of the number of sites in which osteotomy was performed. A promise to be your partner in pediatric care references 1. Feb 17, 2016 stepcut osteotomy derosa and graziano posterior approach. This opening is fixed in position with a plate and screws. Twenty hips 83% had a concomitant femoral osteotomy and thirteen 54% had an anterior open reduction of the hip in addition to the dega osteotomy. Percutaneous pelvic osteotomy in cerebral palsy patients.
Nov 28, 2012 the surgical management of neglected developmental dysplasia of the hip ddh in walking children has always been a challenge to orthopedic surgeons. Dega osteotomy for the correction of acetabular dysplasia. Combined onestaged open reduction, femoral osteotomy, and dega pelvic osteotomy for developmental dysplasia of the hip. If the orthopedist performed the osteotomy without open reduction of the hip, you should use 27146 osteotomy, iliac, acetabular or innominate bone. Osteotomy fact sheet osteotomy tibial osteotomy is a very useful operation for the younger patient who has osteoarthritis in one side of the knee typically the inner side or the medial side. The management of developmental dysplasia of the hip ddh in walking children is difficult. The socket sometimes gets worn down on the edge of the socket when the head of the femur rubs on the edge of the socket from being partly out of the joint. The dega osteotomy is named for the physician who first wrote about it. This is done when the socket is too wide and too shallow. Dega osteotomy for the management of developmental.145 1097 877 1027 585 574 574 732 82 1091 468 675 65 387 979 206 1554 1105 284 154 1455 1522 378 44 304 927 1270 1595 1356 1488 15 712 87 912 974 920 1061 699