Pelvic osteotomies for hip dysplasia

Purpose of review: The purpose of this paper is to discuss the current trends in pelvic osteotomies for the treatment of developmental dysplasia of the hip. Recent findings: The recent literature reports on midterm to long-term results of three types of pelvic osteotomies for hip dysplasia. The Chiari osteotomy has been shown to be effective in delaying the need for total hip arthroplasty in patients with dysplasia, hip inconguity, and osteoarthritis. Spherical osteotomies, which are mostly performed in the centers in which they were developed, have good results but are limited by the inability to medialize the acetabular fragment. The Bernese periacetabular osteotomy shows good midterm results even in patients with severe dysplasia who have not been considered surgical candidates for an acetabular reorientation in the past. Summary: Patients with hip dysplasia are at increased risk for the development of osteoarthritis because of joint overload. A variety of pelvic osteotomies to redistribute the forces have been developed. Reports of long-term follow-up of the Chiari osteotomy are reasonable for young patients with an incongruent hip joint and arthritis who desire a joint-sparing procedure. The current trend for the treatment of acetabular dysplasia in the skeletally mature patient with a congruent hip joint is the Bernese periacetabular osteotomy. Although it is technically challenging, significant reorientation of the acetabulum can be achieved in all planes, including anterolateral coverage, restoration of acetabular version, and hip joint medialization.