Novel Minimally-Invasive Triple Pelvic Osteotomy: JiShuiTan Minimally-Invasive Approach

Purpose: Triple pelvic osteotomy (TPO) is often performed to improve femoral head coverage, correct deformity, and stabilize the hip joint in a variety of pediatric orthopaedic conditions. After the TPO was first reported, many modifications were developed to simplify or improve the procedure, however, because of the specific anatomy with several critical nerves and vessels passing through the approaches, extensive exposure and prolonged intraoperative fluoroscopy are often required for TPO. This report introduces a novel, minimally-invasive surgical approach that minimizes the time of intraoperative fluoroscopy and size of the surgical incision, and reviews our experience. Methods: A total of 48 hips in 43 patients with a mean age of 8.3 +/- 1.7 years (range: 6.0 to 12.2 y) were included in this study. Of these, 21 patients (22 hips) had Legg-Calve-Perthes disease (LCPD) and 22 patients (26 hips) had developmental dysplasia of the hip (DDH). The TPOs were performed using the novel, minimally-invasive TPO approach, with a mean postoperative follow-up of 38 months (range: 24 to 54 mo) in the DDH group and 44 months (range: 23 to 58 mo) in the LCPD group. The acetabular index (AI), femoral head migration rate (MP), center edge angle (CEA) and the Severin and Stulberg classification systems were used to evaluate the preoperative and postoperative results. SPSS software was used to analyze the data. Results: The AI decreased from 33.8 degrees +/- 9.2 to 2.9 degrees +/- 10.1, the lateral CEA increased from -10.8 degrees +/- 23.8 to 34.1 degrees +/- 9.9, and the femoral head MP decreased from 64.0%+/- 19.8% to 1.1%+/- 2.6% in the DDH group at last follow-up, indicating significant improvement. The AI decreased from 20.8 degrees +/- 4.7 to -1.3 degrees +/- 7.3, the lateral CEA increased from 6.8 degrees +/- 11.5 to 42.3 degrees +/- 6.4, and the femoral head MP decreased from 42.2%+/- 13.0% to 1.3%+/- 3.3% in the LCPD group at last follow-up, also indicating significant improvement. Conclusion: This approach can simplify the TPO, making the complex operation safer, more effective, and capable of achieving satisfactory correction.