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Survival of Birmingham Interlocking 
Pelvic Osteotomy 
Dylan Jewell 
Callum McBryde 
John O’Hara 
The Royal Orthopaedic Ho...
Dysplastic Hips
The Problem 
• What would you expect?
Hip Alignment~Tyre Alignment 
• Normal alignment = 40,000 miles 
• Out of alignment = 15,000 miles 
• Realigned = ?30,0000...
Indications for surgery 
• Hip dysplasia 
• Centre-Edge-Angle < 30° 
• Adult Acetabular Index >10° 
• Incorrect acetabular...
Socket - Radiological Aims 
• Adult acetabular index <10° 
• Acetabular anteversion 
– Apical = 0° 
– Deep socket = 20° 
–...
Radiological 
Aims 
Femur 
Sourcil/weightbearing 
zone almost horizontal 
Greater trochanter level 
with centre of femoral...
Bone Cuts
Planning the Bone Cuts 
Rotate the 
X-ray ! 
20deg LR 
2020° 
A 
B 
C
Fixator/Screw 
Positions 
• Reflect bone cuts 
Screw 1 
Inserted 
In IR 10 
deg: 
Moves to 
vertical 
A B C 
1 
2 
==Physi...
Alignment verification (all post-op 
patients seen January 1991-97) 
Physiological apical and deep socket 
anteversion
Operative Details 
• Ischium [lateral pos] as per Tonnis 
• Pubis as vertical as possible
Orthofix Screws 
• No 1 screw next 
to QLP just 
above (old) TRC, 
• Vertical in both 
planes, then 
adjust for 
antiversi...
Iliac Osteotomy 
• 12mm saw 
• Cuts A,B,C, 
• Reflect 
primary 
correction 
A 
B C 
2 1 
A 
B C 
C 
B 
A
Fixation 
• No 1 screw 
replaced with 
6.5 canc, 4- 
hole plate 
upto SIJ 
• Iliac crest 
screw 
• Bone graft
Method 
• First 100 patients identified 
• Patient demographics and outcome 
determined from questionnaires, hospital 
not...
Results 
• 117 TPOs performed by JOH 
• 3 TPOs without follow-up 
• Mean follow-up 10 years (0 to 20) 
• Mean age 31 (rang...
Survival Curve
Age 
• Our age range was 7 to 57 years 
• Increasing age was significantly associated 
with a worse survival with arthropl...
<20 yrs: 89%, 18 pts 
<25 yrs: 76%, 32 pts 
<30 yrs: 67%, 54 pts 
Survival for Age of Operation 
Years post operation 
Sur...
Secondary Outcomes 
• Oxford Hip Score Median 41 (interquatile range 24-46) 
• UCLA: 5 (interquatile range 3-7)
UCLA 
1. Wholly inactive: dependent on others and can not leave house. 
2. Mostly inactive: very restricted to minimum act...
Neonatal Septic 
dislocation 
6yrs
13yrs
Now 20yrs FU, 
Excellent function, 
Dance leader on a ship
Complications 
• 1 PE(from contralateral leg) 
• 2 DVT (1 of which in non-operated leg) 
• 3 Non-union united after bone g...
Conclusions 
• The Birmingham Interlocking Pelvic 
Osteotomy provides a valuable tool to 
accurately correct acetabular dy...
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Interlocking Triple Pelvic Osteotomy - John O'Hara

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A deck showing the Survival of the Interlocking Triple Pelvic Osteotomy by John O'Hara Consultant Orthopaedic Surgeon, from Birmingham, United Kingdom.

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Interlocking Triple Pelvic Osteotomy - John O'Hara

  1. 1. Survival of Birmingham Interlocking Pelvic Osteotomy Dylan Jewell Callum McBryde John O’Hara The Royal Orthopaedic Hospital Birmingham UK
  2. 2. Dysplastic Hips
  3. 3. The Problem • What would you expect?
  4. 4. Hip Alignment~Tyre Alignment • Normal alignment = 40,000 miles • Out of alignment = 15,000 miles • Realigned = ?30,0000 miles • If not….
  5. 5. Indications for surgery • Hip dysplasia • Centre-Edge-Angle < 30° • Adult Acetabular Index >10° • Incorrect acetabular version • Interruption of the lateral Iliofemoral line
  6. 6. Socket - Radiological Aims • Adult acetabular index <10° • Acetabular anteversion – Apical = 0° – Deep socket = 20° – Transverse ligament plane ~ 20°
  7. 7. Radiological Aims Femur Sourcil/weightbearing zone almost horizontal Greater trochanter level with centre of femoral head Round Head • Anteversion= 20°
  8. 8. Bone Cuts
  9. 9. Planning the Bone Cuts Rotate the X-ray ! 20deg LR 2020° A B C
  10. 10. Fixator/Screw Positions • Reflect bone cuts Screw 1 Inserted In IR 10 deg: Moves to vertical A B C 1 2 ==Physiological acetabular anteversion!!!
  11. 11. Alignment verification (all post-op patients seen January 1991-97) Physiological apical and deep socket anteversion
  12. 12. Operative Details • Ischium [lateral pos] as per Tonnis • Pubis as vertical as possible
  13. 13. Orthofix Screws • No 1 screw next to QLP just above (old) TRC, • Vertical in both planes, then adjust for antiversion • No 2 position corrects dysplasia angle 11 2
  14. 14. Iliac Osteotomy • 12mm saw • Cuts A,B,C, • Reflect primary correction A B C 2 1 A B C C B A
  15. 15. Fixation • No 1 screw replaced with 6.5 canc, 4- hole plate upto SIJ • Iliac crest screw • Bone graft
  16. 16. Method • First 100 patients identified • Patient demographics and outcome determined from questionnaires, hospital notes, telephone interviews. • Primary Outcome: Survival before Resurfacing/THR required. • Secondary Outcomes: OHS and UCLA score
  17. 17. Results • 117 TPOs performed by JOH • 3 TPOs without follow-up • Mean follow-up 10 years (0 to 20) • Mean age 31 (range 7 – 57) • Mean Acetabular Index pre-op 23 • Mean Acetabular Index post-op 2 • 37 Arthroplasties at mean 8 years (95% CI 6.8 – 9.3)
  18. 18. Survival Curve
  19. 19. Age • Our age range was 7 to 57 years • Increasing age was significantly associated with a worse survival with arthroplasty as the end-point (p=0.02)
  20. 20. <20 yrs: 89%, 18 pts <25 yrs: 76%, 32 pts <30 yrs: 67%, 54 pts Survival for Age of Operation Years post operation Survival
  21. 21. Secondary Outcomes • Oxford Hip Score Median 41 (interquatile range 24-46) • UCLA: 5 (interquatile range 3-7)
  22. 22. UCLA 1. Wholly inactive: dependent on others and can not leave house. 2. Mostly inactive: very restricted to minimum activities of daily living. 3. Sometimes participates in mild activities, such as walking, limited housework and limited shopping. 4. Regularly participates in mild activities. 5. Sometimes participates in moderate activities such as swimming or could do unlimited housework or shopping. 6. Regularly participates in moderate activities. 7. Regularly participates in active events such as bicycling . 8. Regularly participates in active events, such as golf or bowling. 9. Sometimes participates in impact sports such as jogging, tennis, skiing, acrobatics, ballet, heavy labour or backpacking. 10. Regularly participates in impact sports.
  23. 23. Neonatal Septic dislocation 6yrs
  24. 24. 13yrs
  25. 25. Now 20yrs FU, Excellent function, Dance leader on a ship
  26. 26. Complications • 1 PE(from contralateral leg) • 2 DVT (1 of which in non-operated leg) • 3 Non-union united after bone grafting • 1 temporary sciatic nerve palsy • 2 lateral cutaneous nerve injuries • 1 infection
  27. 27. Conclusions • The Birmingham Interlocking Pelvic Osteotomy provides a valuable tool to accurately correct acetabular dysplasia, • Preserving hip function and delaying arthroplasty surgery. • Does labral pathology matter, once the socket is corrected??
  • AnmBazlurRashidTulu

    May. 5, 2015

A deck showing the Survival of the Interlocking Triple Pelvic Osteotomy by John O'Hara Consultant Orthopaedic Surgeon, from Birmingham, United Kingdom.

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