Eccentric Rotational Acetabular Osteotomy Using Computed Navigation Guidance for Developmental Dysplasia of the Hip, Sacroiliac Fusion, and Femoroacetabular Impingement Owing to Acetabular Retroversion: A Case Report. Issue 7 (22nd September 2021) - Shimamura, Masashi
Abstract : Background: Developmental dysplasia of the hip (DDH) is the main factor that causes secondary osteoarthritis of the hip (hip OA). Acetabular retroversion results in pincer‐type femoroacetabular impingement (FAI), and this is also known to cause secondary hip OA. However, few cases of DDH with acetabular retroversion have been reported, and there is no definite opinion on the optimal treatment. We report a rare case of DDH and FAI owing to acetabular retroversion and dysostosis of the sacroiliac joint that was treated with eccentric acetabular rotational osteotomy (ERAO) using navigation guidance. Case Presentation: A 27‐year‐old woman presented with DDH and acetabular retroversion with FAI and dysostosis of the sacroiliac joint on the contralateral side. We performed ERAO using computed navigation guidance and improved the coverage and retroversion of the acetabulum. The acetabular anteversion angle improved from 1° retroversion to 9° anteversion after surgery, the center edge angle improved from 18° to 43°, and the acetabular head index improved from 69% to 93%. The cam lesion of the femur was resected. The Harris Hip Score improved from 55.7 to 100 points at the final examination 2 years after surgery. Conclusions: In this rare case of DDH and FAI, ERAO using computed navigation guidance accurately improved the coverage and retroversion of the acetabulum. Abstract : All images show lateral views of the acetabulum and femur. Preoperative planning image shows the osteotomy line (the purple line) and cam lesion (the green area) and a chisel. Postoperative image shows 1: Eccentric rotational acetabular osteotomy for improvement of the coverage and retroversion of the acetabulum, 2: Poly‐L‐lactic acid screw for fixing the osteotomy fragments, 3: Resection of the cam lesion, 4: Repair of the hip labrum tear using a surgical anchor with sutures.