Radiographic Outcomes of Ganz versus Modified Triple Osteotomies in Femoral Head Medialization and Coverage in Acetabular Dysplasia

Abstract

Variable techniques in periacetabular osteotomy have been formulated for the treatment of acetabular dysplasia. However, few studies have compared the radiographic outcomes between different osteotomy types. This study compared modified triple innominate (MTI) osteotomy and Ganz osteotomy with respect to radiographic outcomes. Patients receiving MTI osteotomies and Ganz osteotomies at any time between 2006 and 2018 in a tertiary medical centre were recruited. Only patients with unilateral osteotomies were recruited to eliminate potential influence from the contralateral hip following periacetabular osteotomy. Patients having hip-joint dislocation, receiving simultaneous proximal femoral osteotomy, or having fewer than 2 years of follow-up were excluded. The radiographic parameters of preoperative and postoperative anteroposterior radiographs of the pelvis were measured, and Sharp’s angle (SA), the lateral centre-edge angle (CE angle), the femoral head extrusion index (FHEI), and the centre-head distance discrepancy (CHDD) were included for comparison. Among 55 participants, 23 received MTI osteotomies and 32 received Ganz osteotomies. The mean age at which patients underwent surgery was 21.9 years in the Ganz osteotomy group and 21.1 years in the MTI group. The mean follow-up length was 2.5 years. The preoperative radiographic parameters between groups differed only slightly and nonsignificantly. Both groups exhibited significantly improved SA, LCEA, and FHEI after surgery. The Ganz osteotomy group exhibited more favourable postoperative FHEI (13.5 vs. 24.3, p < 0.0001), CHDD (3.7 vs. 11.5, p < 0.0001), Sharp angle (45.0 vs. 41.8, p = 0.0489) and CE angles (28.3 vs. 21.1, p = 0.029) compared with the MTI osteotomy group. Notably, CHDD became better and worse following Ganz and MTI osteotomies, respectively; this suggests that the femoral head is pushed laterally in modified triple osteotomy. With respect to femoral head coverage and the medialization of the femoral head, Ganz osteotomy exhibits more favourable corrections in postoperative radiographic parameters than does MTI osteotomy.