This document discusses acetabuloplasties, which are surgical procedures to correct acetabular dysplasia. It outlines the indications for acetabuloplasty such as developmental dysplasia of the hip, Perthes disease, and residual dysplasia after other procedures. Assessment methods for dysplasia like the acetabular index and central-edge angle are also described. The main types of acetabuloplasties are categorized as redirectional, restructural, or augmentative procedures and examples are given like Salter's osteotomy, Pemberton's osteotomy, and use of a shelf or Chiari pelvic osteotomy.

1. Indications and Types
Prof. Mamoun Kremli
Dean, College of Medicine
AlMaarefa Colleges
Riyadh, Saudi Arabia
Acetabuloplasties

2. Objectives
 Indications for acetabuloplasty
 Assessment of acetabular dysplasia
 Types of Acetabuloplasties

3. Indications for Acetabuloplasty
 To correct a dysplastic acetabulum
 Stand-alone or with other procedures
 For: CDH, DDH, Perthe,s, Down’s, …

4. Indications for Acetabuloplasty
 CDH – with open reduction
 Discovered after 16m
 DDH – persistent acetabular dysplasia
 After 18m

5. Indications for Acetabuloplasty
 Clear Acetabular dysplasia after 18m of age
(antero lateral uncoverage of femoral head)
5
20o 42o
12o30o
Increased AI. Reduced CE angle (older age)

6. Indications for Acetabuloplasty
 Residual acetabular dysplasia in treated CDH not
satisfactorily correcting:
 Serial follow-up x-rays. (acetabular angle / shape)
 No improvement after one year of observation
 (best before age 3 years )

7. Indications for Acetabuloplasty
Pattern of Acetabular Development
From Staheli, Practice of pediatric Orthopedics, 2001
Lidstrom et al:JBJS Am 1979;61

8. Indications for Acetabuloplasty
 Recently discovered acet. dysplasia in adolescents
 Asymptomatic
 Fatigue pain after activity

9. Indications for Acetabuloplasty
 Acet. dysplasia causing hip subluxation
 In any age >18 m
18 m 3 yrs

10. Assessment of Acetabular Dysplasia
 Acetabular Index (Tonnis)
 Central-edge angle
 (CE 30-35)
 Saurcel:
 Sclerotic line of weight-bearing should be horizontal
 Shenton’s line
 AP standing
 Lateralization
 Arthrography

11. Assessment of Acetabular Dysplasia
 Central-edge angle
 (CE 30-35)
12o30o

12. Assessment of Acetabular Dysplasia
 Saurcel:
 Sclerotic line of weight-bearing should be horizontal

13. Types of Acetabulo-plasties
 Redirectional:
 Changes the direction/rotation of the acetabulum
 Restructural:
 Changes the shape/size of the acetabulum
 Augmentation:
 Increases the cover/size of the acetabulum

14. Redirectional Acetabulo-plasties
 Salter’s (& modifications) < 8 yrs
 Double innominate – Sutherland > 8 yrs
 Triple – Steel – Tonnis > 8 yrs
 Ganz – Bernese >15 yrs
 Wagner – Eppright - dial >15 yrs

15. Restructural Acetabulo-plasties
 Pemberton’s
 Dega’s

16. Augmentation Acetabulo-plasties
 Shelf
 Chiari

17.  Redirectional:
 Changes the direction/rotation of
the acetabulum
 Restructural:
 Changes the shape/size of the
acetabulum
 Augmentation:
 Increases the cover/size of the
acetabulum
 Salter’s
 Pemberton’s
 Dega’s
 Shelf
 Chiari
Types of Acetabulo-plasties