1. 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

2. 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

3. Pelvic osteotomies are effective
4 yrs old
Bone graft placed

4. 17y/o
Cash, kyle

5. 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

6. 9mos post-op
19mos post-op
Balotti Snodgrass, Julie

7. 12 y/o post-op 3yrs; ↓ R hip flexion
false profile
R hip max flexion 60º painful
Bili, Allison

8. Ant-Lat over coverage
Bili, Allison

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

10. 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

11. 22y/o L hip pain 2° to ant. impingement
Post
Redo Ganz
Snodgrass, Julie 2005

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

13. False Profile

14. Placing bone graft

15. Stabilizing bone graft

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

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

20. Bone graft placed
4 yrs old

21. 4y/o OC
Clark, Olvia &

22. POST
PRE
Clark, Olivia

23. Post CR 2+6 yrs old
Jon’s Case

24. 5y/o male
8mos post-op
& Cinch Davis

25. 2 years post op

26. Cinch Davis

27. 6y/o 2 yrs post tx 10y/o “lots” of coverage
Bilat OR, PFO, Pemb
Enough coverage?
6y/o yrs post tx
10y/o “lots” of coverage

28. 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?

29. 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

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

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

32. Obrigado
Thank you