The Donau Hospital Stolzalpe concept. Corrective osteotomy with selective labral surgery after preoperative MR arthrography

Concomitant pathologies (labral lesions, intra-/extra-osseous ganglia and s tress bone marrow edema) in adult residual hip dysplasia (RHD) might influe nce the outcome of conservative hip surgery. The aim of our prospective cli nical study was to assess the value of preoperative MR arthrography in diag nosing concomitant lesions and in making surgical decisions in RHD. The fir st 37 consecutive patients with a minimum follow-up of 18 months have been analysed. All 37 patients presented RHD with the clinical symptomatology of labral lesions and underwent routine preoperative MRA. According to clinic al, radiological and MR arthrographical criteria, these 37 patients were su bdivided into four therapeutic subgroups: (1) reorientation of the acetabul um using the Tonnis triple pelvic osteotomy (TPO); (2) intertrochanteric va risation osteotomy (IVO); (3) palliative decompression with only symptomati c partial resection of the torn labrum (PALI); (4) primary total hip replac ement (TEP). Based on the preliminary clinical and radiological outcomes of these four subgroups, the following conclusions can be drawn: labral lesio ns are considered to be a sign of chronic joint instability. Therefore, ace tabular malorientation should be corrected by redirectional osteotomy of th e acetabulum (TPO-subgroup) even in low grades of RHD if labral lesions are present. "Palliative" labral resections without corrective osteotomy (PALL subgroup) in secondary osteoarthritis due to RHD are definitively obsolete , because they rapidly progress to severe osteoarthritis due to surgically accelerated joint instability. In RHD with highly osteoarthritic hip joints and concomitant lesions, one should not hesitate to perform primary THR ev en in young patients.