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

1. Survival of Birmingham Interlocking
Pelvic Osteotomy
Dylan Jewell
Callum McBryde
John O’Hara
The Royal Orthopaedic Hospital Birmingham
UK

2. Dysplastic Hips

3. The Problem
• What would you expect?

4. Hip Alignment~Tyre Alignment
• Normal alignment = 40,000 miles
• Out of alignment = 15,000 miles
• Realigned = ?30,0000 miles
• If not….

5. Indications for surgery
• Hip dysplasia
• Centre-Edge-Angle < 30°
• Adult Acetabular Index >10°
• Incorrect acetabular version
• Interruption of the lateral Iliofemoral line

6. Socket - Radiological Aims
• Adult acetabular index <10°
• Acetabular anteversion
– Apical = 0°
– Deep socket = 20°
– Transverse ligament plane ~ 20°

7. Radiological
Aims
Femur
Sourcil/weightbearing
zone almost horizontal
Greater trochanter level
with centre of femoral
head
Round Head
• Anteversion= 20°

8. Bone Cuts

9. Planning the Bone Cuts
Rotate the
X-ray !
20deg LR
2020°
A
B
C

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. Alignment verification (all post-op
patients seen January 1991-97)
Physiological apical and deep socket
anteversion

12. Operative Details
• Ischium [lateral pos] as per Tonnis
• Pubis as vertical as possible

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. Iliac Osteotomy
• 12mm saw
• Cuts A,B,C,
• Reflect
primary
correction
A
B C
2 1
A
B C
C
B
A

15. Fixation
• No 1 screw
replaced with
6.5 canc, 4-
hole plate
upto SIJ
• Iliac crest
screw
• Bone graft

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. 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. Survival Curve

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 yrs: 89%, 18 pts
<25 yrs: 76%, 32 pts
<30 yrs: 67%, 54 pts
Survival for Age of Operation
Years post operation
Survival

21. Secondary Outcomes
• Oxford Hip Score Median 41 (interquatile range 24-46)
• UCLA: 5 (interquatile range 3-7)

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. Neonatal Septic
dislocation
6yrs

24. 13yrs

25. Now 20yrs FU,
Excellent function,
Dance leader on a ship

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. 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??