n tips & techniques Section Editor: Steven F. Harwin, MD Double-Level Pelvic Osteotomy for Managing Persistent Acetabular Dysplasia Abdulrahman D. Algarni, MD, SSC (Ortho), ABOS; Fikry Abdelfattah, MD, MSc; Abdulaziz Al-Ahaideb, MBBS, FRCSC; Hamza M. Alrabai, MD, SB-Orth, JMC (Ortho); Shaji John Kachanathu, PT, PhD; Hazem Al-Khawashki, MD, FRCS; Mamoun Kremli, MBBS, FRCS I n 1965, Paul Pemberton described his pericapsular pelvic osteotomy. 1 Since then, it has been widely adopted for the treatment of acetabu- lar dysplasia. 2-6 Pemberton’s osteotomy is characterized by a redirection of the acetabular roof, hinging on the triradiate cartilage after an incomplete iliac osteotomy. The shape of the acetabuloplasty is modified by rotating the acetabular frag- ment caudally and anteriorly to improve the anterior and lateral coverage of the femoral head. Pemberton 1 pointed out in his original article that congenital dislocation or subluxation of the hip is ac- companied by a significant defect in the anterior portion of the acetabulum and that the treatment for such dysplasia should include correction of this defect. In this article, the authors describe the surgical technique of a double-level pelvic oste- otomy performed by the senior author (M.K.) to overcome the persistent acetabular dyspla- sia. To the authors’ knowledge, this technique has never been reported. SURGICAL TECHNIQUE An 8-year-old girl known to have Fanconi’s syndrome with multiple congenital anomalies presented to the senior author (M.K.) after failed attempts of open reduction for a right con- genital hip dislocation. Clinical evaluation revealed a short- limbed gait on the affected side and an exaggerated internal ro- tation indicating an excessive femoral anteversion. Indeed, the femoral head could be seen and felt anteriorly in the groin. Initial radiographs showed sub- luxated hip and acetabular dys- plasia. The patient subsequently underwent open reduction, cap- sulorrhaphy, Pemberton‘s oste- otomy, and femoral derotation osteotomy. Unfortunately, the hip subluxation and femoral anteversion gradually recurred and the femoral head could still be felt in the groin on external rotation, indicating a significant anterior acetabular dysplasia (Figure 1). A radiograph and a 3-dimensional computed to- mography scan are shown in Figure 1. In this case, there were lateral, anterior, and posterior acetabular deficiencies. An acetabuloplasty that could im- prove the lateral coverage and, to a larger extent, provide a lot of anterior coverage without increasing the posterior ace- tabular deficiency was needed. On the basis of these findings, the senior author (M.K.) de- cided to proceed with a dou- ble-level pelvic acetabuloplas- ty to overcome the persistent The authors are from the Department of Orthopedic Surgery (ADA, AA, HMA, HA) and the Department of Rehabilitation Health Sciences (SJK), King Saud University; the Department of Orthopedic Surgery (FA), Dallah Hospital; and Almaarefa College for Science and Technology (MK), Riyadh, Saudi Arabia. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Hazem Al-Khawashki, MD, FRCS, Department of Orthopedic Surgery, King Saud University, PO Box 7805 (49), Riyadh 11472, Saudi Arabia (hazemal-khawashki@hotmail.com). Received: February 21, 2015; Accepted: July 29, 2015. doi: 10.3928/01477447-20160513-06 Abstract: Pemberton’s osteotomy has been recognized as a standard technique for the treatment of acetabular dysplasia. The aim of this article is to describe the surgical technique of a double-level pelvic osteotomy. To the authors’ knowledge, this technique has never been reported. The osteotomy was performed in a case of severe pan-acetabular dysplasia where a single, classic Pemberton’s osteotomy was not sufficient to provide adequate coverage. The described osteotomy provid- ed sufficient acetabular coverage and overcame the persistent acetabular dysplasia. [Orthopedics.] 1