Modified Chiari pelvic osteotomy: a long-term follow-up study.

In a series of 100 modified Chiari pelvic osteotomies in ninety-six patients, who were followed for an average of nine years and three months (range, six years to fourteen years and eight months), an excellent or good clinical result was obtained in seventy-eight hips. The level of the osteotomy line on postoperative radiographs was compared with the clinical result. The average clinical result was good in seventy-four (84 per cent) of the eighty-eight patients in whom the osteotomy was at the I-I, I-II, or II-II level, according to the classification of levels by Azuma et al., but was good in only four of the twelve patients in whom the osteotomy was at another level (p = 0.0003). We found that smooth anterior and lateral coverage can be obtained by the use of a dome-shaped osteotomy line.     

Chiari osteotomy of the pelvis: a long-term study

We evaluated 104 osteotomies of the pelvis after an average of 18 years: 48% of patients had hip joint pain, 15% had low back pain, 41% had restricted movement, 74% had a positive Trendelenburg sign, and 77% had limb length discrepancy greater than 1 cm. We also followed the anti-Chiari effect, the influence of the osteotomy on narrowing the birth canal, and deterioration of the opposite acetabulum. We showed that the optimum indications for Chiari osteotomy are severe instability of the hip joint and an irregular femoral head.     

Factors influencing the outcome of Chiari pelvic osteotomy: a long-term follow-up

We have reviewed 103 of 126 Chiari osteotomies carried out in our department between 1956 and 1987. The cases were graded radiologically, using the Japanese Orthopaedic Association (JOA) system, into a pre/early osteoarthritis (OA) group and an advanced OA group. In the pre/early group there were 86 hips. The mean follow-up was for 17.1 years (4 to 37). Preoperatively, 51 hips had an average JOA clinical score of 78.6+/-8.4 points and the final mean JOA clinical score was 89.4+/-12.5 points. Advanced degenerative change developed in 33.7% and one hip required a total replacement arthroplasty (TRA). Chiari osteotomy alone, without accompanying intertrochanteric osteotomy, was performed on 62 hips. For these the median survival time was 26.0+/-2.5 years, using as the endpoint progression to advanced OA. Differences in survivorship curves related significantly to the severity of the preoperative OA, the shape of the femoral head and the level of osteotomy. In the advanced OA group, we followed up 17 hips for a mean of 16.2 years (1 to 27). Before operation, the mean JOA clinical score in 13 hips was 63.2+/-7.9 points and the final score 84.0+/-12.0 points. TRA was eventually carried out on four hips. Our findings suggest that the Chiari osteotomy remains radiologically effective for about 25 years. The procedure is best suited to subluxated hips with round or flat femoral heads and early or no degenerative change. Intra-articular osteotomy can lead to osteonecrosis, and should be avoided. In hips with advanced OA, the Chiari procedure creates an acetabulum which facilitates later TRA, and may delay the need for this procedure in younger patients.     

Chiari截骨术治疗成人髋发育不良的远期随访

目的:对成人髋发育不良行Chiari截骨术进行远期随访,评估该治疗方法的有效性.方法:对接受Chiari截骨术治疗的病人,分别测定其术前和术后JOA评分、中心边缘角和Sharp角、术后截骨远端内移率和截骨平面的高度,并对影响结果的因素进行相关性分析.结果:平均随访时间为12.8年,病人38例,共45侧髋,其中男3例,女35例,手术时平均年龄为38.5岁.45侧髋中,有17例髋关节骨性关节炎得到明显改善,占37.7%;有13侧髋关节骨性关节炎无明显变化,占28.9%;有15侧髋关节骨性关节炎病变继续恶化,占33.3%.术前JOA平均为59.9分,术后83.8分.术后疗效为优占37.0%,良占34.2%,一般占15.5%,差占13.3%.术前平均中心边缘角-11.5°,术后为24.6°.术前平均Sharp角为54.4°,术后平均为43.3°.平均截骨角度为7.51°,股骨头顶点至截骨平面的距离平均为8.17mm.截骨远端内移率平均值为33.6%.结论:经过10年以上的随访表明,Chiari截骨术能使成人髋发育不良的疼痛症状得到缓解,一部分病人骨性关节炎的过程得到有效的遏制.     

Chevron osteotomy for correction of hallux valgus: a long-term follow-up study

Seventy-six consecutive patients with 106 bunions were examined 6 years after chevron osteotomy. The feet were evaluated clinically and radiologically. The American Orthopaedic Foot and Ankle Society (AOFAS) scale (0–100) was used. The mean age of the patients was 46 years at time of operation. Ninety-six % of the operated patients were female. At 6 year follow-up, the hallux valgus angle was 17,9 degrees (range, 2–42 degrees) and the intermetatarsal angle was 10,5 degrees (range, 4–20 degrees). The change of the hallux valgus angle (compared to the preoperative X-ray picture) was 6,4 degrees (P<0,001, 95% confidence interval 4,0 to 8,7 degrees). The mean AOFAS score was 81 (±SD15). The study indicates that the long term results of chevron osteotomy are variable. The clinical evidence of effectiveness is still weak and there is an obvious need for randomized controlled trials in this field.     

The Chiari pelvic osteotomy for patients with dysplastic hips and poor joint congruency: long-term follow-up

We report the mid- to long-term (mean 20.3 years, 10 to 32.5) results of the Chiari pelvic osteotomy in patients with pre- to advanced stage osteoarthritis in dysplastic hips. We followed 163 Japanese patients (173 hips) with a mean age at surgery of 20 years (9 to 54). Overall, 124 hips (72%) had satisfactory results, with Harris hip scores ≥ 80. Satisfactory results were seen in 105 of 134 hips with pre- or early osteoarthritis (78%) and 19 of 39 hips with advanced osteoarthritis (49%). A total of 15 hips (9%) underwent a total hip replacement (THR) with a mean interval between osteotomy and THR of 16.4 years. With conversion to THR as the endpoint, the 30-year survival rate was 85.9% (95% confidence interval 82.3 to 89.5). It was 91.8% for patients with pre- or early osteoarthritis and 43.6% for those with advanced osteoarthritis (p < 0.001). We now perform the Chiari osteotomy for patients with dysplastic hips showing poor joint congruency and who prefer a joint-conserving procedure to THR.     

Valgus high tibial osteotomy. A long-term follow-up study

One hundred twenty-eight knees in 107 patients with osteoarthrosis treated by valgus high tibial osteotomy were clinically reviewed. Patients were reviewed from three to 15 years postoperatively (mean, 7.5 years). The revision rate in the osteoarthrotic population was 10.9%. Patients who were older than 60 years of age at the time of surgery had results comparable to those patients who were younger than 60 years of age at the time of surgery. Women and men appeared to have a similar prognosis; 79.6% good and excellent results up to nine years; at ten to 15 years, 70% good and excellent.     

Pelvic remodelling after the Chiari osteotomy. A long-term review

Survivorship analysis of 215 medial displacement pelvic osteotomies undertaken for symptomatic, incongruent dysplasia of the hip since 1966 showed that four of every five hips had not required conversion to a total hip arthroplasty. The radiological characteristics of 86 osteotomies were evaluated at a mean of 18 years (5 to 30) after surgery which was performed at the age of 15.9 +/- 9.5 years. Revision was significantly (p < 0.05) more likely in those patients operated on after the age of 25 years. The centre-edge (CE) angle increased from 2.5 +/- 13.9 degrees before to 41.8 +/- 15.0 degrees immediately after operation. The increase in CE angle was maintained at later review (38.5 +/- 16.5 degrees). Even with severe dysplasia with a CE angle less than zero a substantial improvement in the cover of the femoral head was achieved, usually by medial shift of the lower pelvic fragment. However, the head was not invariably medialised by the osteotomy and lateral movement of the ilium was noted when the position of the joint was relatively medial before operation or when the hip was arthritic. In the longer term pelvic remodelling did not reverse the medialisation produced by the osteotomy, and the cover of the femoral head was maintained.     

Biomechanical evaluation of hip joint after Salter innominate osteotomy: a long-term follow-up study

The biomechanical state of the hip after a Salter innominate osteotomy was investigated by using the radiographic data of 38 operated and 21 contralateral nonoperated hips from our archives. The centre-edge angle of Wiberg was determined from the radiographs taken shortly after the operation. From the radiographs of the latest follow-up (7–13 years after the operation), we also determined the peak value of contact hip joint stress normalized by the body weight, and the functional angle of the weight-bearing area. A mathematical model was used. We show that the geometrical parameters aside from the centre-edge angle may considerably influence the contact hip stress distribution. We also show that the functional angle of the weight-bearing area is a more relevant parameter than the normalized peak stress if the exact magnification of the images is not known and if there is considerable variation of the image size within the sample. The development of the centre-edge angle of the operated hips and of the contralateral hips was also studied. We found that the centre-edge angle increases on average during the follow-up time in the operated hips as well as in the contralateral nonoperated hips, but the average increase is smaller in the former. It is shown that an unfavorable stress distribution is connected to the decrease of the centre-edge angle over time. Finally, we found a weak positive correlation between the centre-edge angle shortly after the operation and the functional angle of the weight-bearing area at the of the latest follow-up. Received: 17 July 2000     

The Chiari pelvic osteotomy. A review of the long-term results

We report the clinical and radiographic results of the Chiari pelvic osteotomy in 49 hips (45 patients) at an average of 14 years after operation. Of these hips, over half had minimal or no pain, had good or excellent results as assessed by the Harris hip score, and could walk at least three miles; three-quarters, however, had a positive Trendelenburg sign. A younger age at operation and a painless hip with no radiographic evidence of degeneration before operation were associated with a higher hip score at review. The percentage of hips without degenerative changes fell from 68% before operation to 15% at final review. There were no major complications and it was found that a Chiari osteotomy need not interfere with normal childbirth.     

胫骨高位截骨术治疗膝内侧室骨关节炎的长期随访

目的观察胫骨高位截骨术治疗膝内侧室骨关节炎的远期治疗效果。方法随访了1985～1996年12年间在德国基尔大学骨科医院行胫骨高位截骨术的194例(215膝)膝内侧室骨关节炎的患者。结果有161膝获得随访,平均随访时间7．5年(1．5～12年)。手术后2年内的优良率为97．3％,5年内的优良率为93．6％,手术后5年以上的优良率为78．2％。12膝发生手术并发症(5．6％),主要为感染(1例深部感染,5例浅表感染),骨不连或骨延迟愈合5例,腓总神经损伤1例。手术后有19膝(11．8％)因治疗效果的下降须再次行全膝关节置换手术。以全膝置换为失败标准的手术成功率分别为：2年98．7％,5年95．0％及10年为84．1％。结论胫骨高位截骨术是治疗膝关节内侧骨关节炎的一种有效手段,术中下肢力线的适当过度纠正是手术成功的关键,远期疗效呈下降趋势．有一部分患者须再次行伞膝关节詈换手术。     

Chiari osteotomy in Legg-Calve-Perthes disease

A retrospective study of 22 Chiari osteotomies in 21 children with severe Legg-Calve-Perthes disease is presented. All cases were studied at skeletal maturity. The average age at surgery was 8.5 years with an average follow-up of 6.1 years. Four hips were classified as Catterall group III and the remaining hips as group IV. Arthrography was used preoperatively to measure the femoral head sphericity, the femoral head coverage and the eccentric index. The same parameters were studied on radiographs at skeletal maturity. Chiari osteotomy provided an improvement in the femoral head coverage and hip congruency. Radiographs showed progressive spherical remodelling of the femoral head and improvement of the concentricity. One hip required premature total hip replacement.     

Chiari osteotomy in cerebral palsy

Twelve cerebrospastic patients underwent 13 Chiari osteotomies for the treatment of subluxed or dislocated hips. Twelve of these 13 hips were reexamined 24-80 months later. Ten patients had painless located hips. The two failures had pelvic obliquity that resulted in redislocation.     

A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

Objective : To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Resnits: One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3 %, 93.6 % and 78.2 % two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure ). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications ( 12 /161 ), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees ) missed follow-up, among them 10 patients (11 knees) died. Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.     

Outcome of Chiari pelvic osteotomy in adults: 90 hips with 2-15 years' follow-up

We studied retrospectively 90 Chiari osteotomies in 83 adults with pain, hip dysplasia and arthrosis. At follow-up after 6 (2-15) years, 35 hips were pain-free, 38 had rare or slight pain, and 17 had moderate or severe pain. The dysplastic acetabulum was corrected in all but 5 cases. There was diminution of arthrosis in 36 hips, no change in 38, and worsening in 16 hips. Functional outcome was best when surgery was performed before the age of 40, and in hips with the greatest degree of dysplasia. However, two thirds of the patients aged over 40 years at surgery had a good result.     

Medial-displacement intertrochanteric osteotomy in the treatment of osteoarthritis of the hip. A long-term follow-up study

Of seventy-three adults who were treated for osteoarthritis of the hip by medial-displacement intertrochanteric osteotomy done by one of us, sixty-one (with sixty-seven treated hips) could be evaluated twelve to fifteen years after osteotomy or at the time when they had an arthroplasty for recurrent symptoms. Specific criteria based on preoperative data were used prospectively to categorize the hips as to their suitability for medial-displacement osteotomy. In addition, at the conclusion of the study, an osteotomy suitability score (maximum score, 12 points) was assessed retrospectively as a determinant of suitability for medial-displacement osteotomy. Ten years after the osteotomy, thirty-four (51 per cent) of the sixty-seven hips had been treated with a cup arthroplasty or total hip arthroplasty. At the conclusion of the study (between twelve and fifteen years after osteotomy), forty-four (66 per cent) of the sixty-seven hips had had an arthroplasty. Among the sixteen hips that had been considered excellent candidates according to the prospective criteria, 85 per cent had not yet required hip arthroplasty five years after osteotomy and two-thirds had not had an arthroplasty ten years after surgery. Of the thirty hips with a suitability score of 7 points or more, 85 per cent had not required arthroplasty at five years and 67 per cent had not done so at ten years. The numerical scoring therefore appeared to be a more reliable determinant of suitability.     

Bariatric surgery in adolescents: a long-term follow-up study

BACKGROUND: The benefits of bariatric surgery in adult obese patients are well known, but data are lacking regarding the outcome of the surgery in adolescents. The aim of this study was to retrospectively assess the operative morbidity and mortality, percentage of loss of initial excess weight, and the incidence of long-term complications and reoperations in a cohort of obese patients who underwent biliopancreatic diversion (BPD) before their 18th birthday. METHODS: A total of 76 adolescent subjects underwent BPD between 1976 and 2005. Of these 78 patients, 7 had Prader-Willi syndrome and 1 had Turner syndrome and were excluded from the study. RESULTS: The patient population comprised 52 girls and 16 boys. Their mean age was 16.8 years, mean body weight at operation was 125 kg (mean body mass index 46 kg/m2). Operative mortality was nil. The mean follow-up was 11 years (range 2-23). The mean percentage of loss of initial excess weight at each patient's longest follow-up was 78%. Before surgery, 33 patients were hypertensive (49%), 11 were dyslipidemic (16%), 3 were hyperglycemic, and 2 had type 2 diabetes. At the longest follow-up period after surgery, only 6 patients were hypertensive, and none were dyslipidemic or diabetic. A total of 19 reoperations were performed in 14 patients (20%), including 7 revisions. Eleven patients developed protein malnutrition 1-10 years after BPD. The long-term mortality rate was 4%. At 4 to 23 years after BPD, 18 of the women had given birth to 28 healthy babies. Three women had had a complicated pregnancy. CONCLUSION: Adolescents can undergo malabsorptive bariatric surgery with excellent long-term weight loss results and an incidence of long-term complications similar to that observed during the 30-year evolution of BPD in our experience.