Problematic Restricted Hip Motion Post Pelvic Osteotomy 5th Semi Annual POSNA/SLAOTI/EPOS (Tri Continental) Pediatric Orthopedic Surgery Symposium Sao Paulo, Brazil October 11-14, 2017 Problematic Restricted Hip Motion Post Pelvic Osteotomy Perry L. Schoenecker, M.D. St. Louis Shriners, St. Louis Children’s & Barnes Hospitals, Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri, USA

Problematic Restricted Hip Motion Post Pelvic Osteotomy 5th Semi Annual POSNA/SLAOTI/EPOS (Tri Continental) Pediatric Orthopedic Surgery Symposium Sao Paulo, Brazil October 11-14, 2017 Problematic Restricted Hip Motion Post Pelvic Osteotomy Perry Schoenecker, MD No Conflicts Or Disclosures Pertinent To Presentations

Pelvic osteotomies are effective 4 yrs old Bone graft placed

17y/o Cash, kyle

Post OR, PFO & Dega, ↓↓↓ R hip flex . . . However, Overcorrection is Very Possible & “Remodeling” varies: Post OR, PFO & Dega, ↓↓↓ R hip flex . . . Why?? false profile Allison Bili

9mos post-op 19mos post-op Balotti Snodgrass, Julie

12 y/o post-op 3yrs; ↓ R hip flexion false profile R hip max flexion 60º painful Bili, Allison

Ant-Lat over coverage Bili, Allison

Ant Post 9mos post-op 19mos post-op Julie Snodgrass Balotti

While lateral tilting & adduction MUST maintain anteversion Millis & Murphy. Periacetabular Osteototmy. In: The Adult Hip 2nd Ed., vol I. 2007:795. While lateral tilting & adduction MUST maintain anteversion 3 3 - anterior tilt 2 2 - medialization 1 1 - lateral tilt & adduction Claire Suntrup

22y/o L hip pain 2° to ant. impingement Post Redo Ganz Snodgrass, Julie 2005

Subluxated dysplastic hip AP False Profile 11y/o Don’t overcorrect . . . an “incomplete osteotomy”

False Profile

Placing bone graft

Stabilizing bone graft

Now assess hip motion Hip extension Hip flexion Must assure >90º of hip flexion . . If not ↓ correction

Enough coverage? 3+6 bilat. Dislocation Bilat OR, PFO, Pemb Maya Newdiger Enough coverage?

Bone graft placed 4 yrs old

4y/o OC Clark, Olvia 9-21-61 & 8-31-16

POST PRE Clark, Olivia

Post CR 2+6 yrs old Jon’s Case

5y/o male 8mos post-op 8-12-15 & 10-12-16 Cinch Davis

2 years post op

Cinch Davis

6y/o 2 yrs post tx 10y/o “lots” of coverage Bilat OR, PFO, Pemb Enough coverage? 6y/o 2 yrs post tx 10y/o “lots” of coverage

What is the “Normal” Range of Hip Motion? “Typically” accepted max hip motion in literature is 120° (hip flexion & lumbosacral motion) . . . . . as assessed by goniometer . . . . How much comes from the hip?

Zaltz I, et. al. CORR 2015; 473:1284 “What is the impingement free ROM of the asymptomatic hip in young adult males”? Assessed by US

Labral Deformation 68° +/-17° Mean Max Flexion 96° +/-6°

Adjust intraoperatively as necessary Surgical correction of acetab dysplasia must be kept in “balance” w/passive hip jt (flexion) motion Adjust intraoperatively as necessary

Obrigado -------------- Thank you