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Ability to be performed in children with both closed and open triradiates
18%
192/1082
Improves posterior coverage
70%
757/1082
No need for bone graft
4%
46/1082
Use of rigid fixation with fully threaded screws
2%
19/1082
Utility as a salvage procedure
5%
57/1082
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The Dega osteotomy is an acetabular reshaping osteotomy that can improve anterior, central, or posterior coverage. Neuromuscular hip disease requires posterior coverage, which can be provided by a Dega or alternatively, a San Diego osteotomy.Cerebral palsy frequently results in hip problems because of the spasticity in the hip flexors and adductors. The most common direction of dislocation is posterosuperiorly (95% of cases). The Reimers migration index is a useful tool to determine the percent of femoral head uncoverage and can guide treatment. Soft tissue releases may be performed in children less than 4 with Reimers index >40%. In children >4 years old or Reimers index >60%, osteotomies are typically indicated in addition to the soft tissue releases.Karlen et al retrospectively reviewed 44 patients with 50 operative hips undergoing Dega osteotomy for the treatment of DDH or neuromuscular disease. In the 24 neuromuscular hips undergoing the osteotomy, there were only 5 complications (1 graft dislodgement, 1 graft collapse, and 3 femoral head lateralization. They concluded that the procedure is safe and effective given its ability to provide either anterior or posterior coverage when needed.Chung et al utilized a three-dimensional CT scan to perform morphometric analysis of 17 hips in cerebral palsy patients that had undergone a Dega osteotomy. They found that the anterosuperior, superolateral, and posterosuperior coverage all improved significantly from those seen in a control group. The mean acetabular volume increased by 68% as well.Figure A is an AP radiograph showing a severely subluxated right hip with a Reimers index >60%.Illustration A demonstrates the osteotomy lines for several common acetabular osteotomies.Incorrect Answers:Answer 1: A Dega osteotomy hinges through the triradiate cartilage and therefore they must be open to perform this osteotomy.Answer 3: Bone graft is typically placed in the bony void left after correction with a Dega osteotomy.Answer 4: The Dega osteotomy does not enter the notch and therefore does not require fixation.Answer 5: The shelf and Chiari osteotomies are the classic salvage procedures for acetabular deficiency.
4.6
(5)
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