Triple Pelvic Osteotomy: Comparison between Direct Lateral Approach and Combined Lateral and Bikini Approaches

Introduction and Objective:
Triple pelvic osteotomy (TPO) involves osteotomies of the ilium, ischium, and pubis in order to reorient the acetabulum into correct weight-bearing position. Several modifications were described; The aim of our study is to evaluate results of TPO using Lateral (LA) and combined Lateral and Bikini approach(BA).

Materials and Methods:
During the past 9 years, we treated 13 patients with various congenital and acquired conditions (7 females and 6 males), mean age 11.6 years, age range (6-31).

TPO was performed in all patients with congenital short femur through lateral approach in 6 patients (all of them also underwent femoral osteotomies).

Seven patients started with femoral exposure in lateral position, after ischial osteotomy and exposure of the femur, were turned supine and continued with femoral osteotomies and completion of the pubis and iliac cuts through bikini approach.

Results:
We did not find significant differences between the two groups in terms of the hip coverage, but all patients with combined exposure had shorter operative time and improved orientation and surgeon’s confidence.

Conclusions:
Despite that LA provide satisfactory access to all structures, we found that it is more difficult than combined approach, addition of the bikini approach saves time and significantly improves surgeon orientation and confidence.