Pelvic osteotomies in children, adolescents and adults

A pelvic osteotomy is a joint preservation operation designed at restoring the normal mechanical environment to the hip joint. Dr Balakumar is a specialist in this area and has the expertise to perform the full range of joint preservation and joint replacement options in children and adults. Osteotomy simply put means “cutting the bone”.

A pelvic osteotomy is done through controlled cuts in the bone of the pelvis to redirect the socket. The types of ostetotomies around the pelvis varies. They are based on what the goals of the operation are. The osteotomy is also based upon if the child or adolescent has open or closed growth plates.

The immature child has very flexible bone and therefore is more amenable to single cuts around the pelvis. The operations around the socket can be divided into volume reducing operations, redirectional operations or salvage.

The latter osteotomy is undesirable but is an available option for someone who may have no other option.

Dega Osteotomy

In the child around or below seven then a volume reducing osteotomy via bikini type incision is made. This is known as a Dega or Pemberton Osteotomy. These osteotomies involve making a single cut in the bone known as ilium. The ilium is then hinged down to allow reduction of the volume of the hip. This confers stability onto the socket.

Salter Osteotomy

The salter osteotomy is also performed to younger children. It is usually done on a child via a bikini incision and a bone cut is performed around the ilium bone. The socket is then reorientated to allow for better coverage. Because only one cut is made the pelvis often hinges on the uncut section. Therefore it does not allow full 3 dimensional correction and can often result in loss of range of motion and secondary problems. However it is the most successful pelvic osteotomy to date, with excellent medium to long term results.

Bernese Triple Osteotomy

The bernese triple osteotomy is performed on a child with open growth plates around socket (Triradiate cartilage). It involves two incisions. One around the inside of the groin crease to make one cut around the ishcium bone of the pelvis. The other skin incision is around the side of the pelvis (bikini type) incision to make two further cuts. The three cuts in the pelvis allow free movement around of the acetabulum around the hip. This is a powerful correction and confers with it multiple risks. It should only be done by experienced surgeons fellowship trained in this operation.

Periacetabular Osteotomy (PAO)

The Ganz PAO is designed to be performed in children, adolescents and adults whose growth plate around the socket has closed (triradiate closure). This is a very complex osteotomy done through a single bikini incision. It involves five cuts in the pelvis bone around the socket. It preserves the pelvic ring thereby inferring intrinsic stability to the osteotomy and pelvis. However it is technically very difficult and has significant complications. Dr Balakumar has been fellowship trained by the world leading authority in this technique. For further information, please read the PAO information sheet.