The clinical presentation is consistent with DDH in a patient with a closed triradiate cartilage. A peri-acetabular osteotomy (Ganz) is the most appropriate treatment.
The peri-acetabular osteotomy (Ganz) is a reconstructive osteotomy for DDH patients with a closed triradiate cartilage. It allows for a large degree of three-dimensional correction because the cuts are close to the acetabulum, it preserves the abductor muscles and allows for inspection of the joint.
Karami et al. performed a Level 4 study of 20 patients with an average 12 years of follow-up that underwent a Chiari osteotomy. They found that the Sharp angle, center-edge angle and coverage of the femoral head all improved with the osteotomy but noted that there was a 25% rate of graft resorption.
Gillingham et al., in a level 5 study, emphasizes the timeline of osteotomy indications for DDH patients. A single innominate osteotomy (Salter) or Pemberton procedure is generally appropriate for a child between the ages of 2 and 10. A triple innominate osteotomy (Steel) is applicable for the older child or adolescent where the triradiate cartilage remains open. After triradiate is closed the Ganz periacetabular osteotomy is an option for DDH reconstruction.
Figure A demonstrates a skeletally mature individual with a center-edge angle that is abnormal and less than 20 degrees. Illustrations A-D are examples of the Salter, Ganz, Steel, and Chiari osteotomies, respectively. Illustration E shows a radiograph of the patient in Figure A following a Ganz osteotomy. Illustration F shows a modeling of the bone cuts utilized in a periacetabular osteotomy (Ganz).
Karami M, Fitoussi F, Ilharreborde B, Penneçot GF, Mazda K, Bensahel H. The results of Chiari pelvic osteotomy in adolescents with a brief literature review. J Child Orthop. 2008 Feb;2(1):63-8. Epub 2008 Jan 3.
PMID:19308604 (Link to Abstract)
Gillingham BL, Sanchez AA, Wenger DR. Pelvic osteotomies for the treatment of hip dysplasia in children and young adults. J Am Acad Orthop Surg. 1999 Sep-Oct;7(5):325-37. Review.
PMID:10504359 (Link to Abstract)