Long-term results of intertrochanteric varus osteotomy for arthrosis of the dysplastic hip (over 10 years' follow-up)

We performed a retrospective clinical and radiographic review of the long-term results of 64 hips in 53 patients who underwent intertrochanteric varus osteotomy for arthrosis of the hip at the pre- or early stage with acetabular dysplasia. Their average age at operation was 26 years. The average duration of follow-up was 18 years and 10 months. The mean Harris hip score was 77 ± 9 points pre-operatively, and improved significantly to 84 ±13 points at the final follow-up. The acetabular coverage influenced the final outcome, and the postoperative prognosis was predictable from the acetabular head index (AHI) on a pre-operatively done hip maximum abduction radiograph (abd XP). We conclude that varus osteotomy for a dysplastic hip should be considered when the acetabular coverage is sufficient, and that a good prognosis can be expected when AHI on abd XP is greater than 60%.     

Isolated varus intertrochanteric osteotomy for hip dysplasia in 52 patients: long-term results

Great strides have been made in the field of total hip arthroplasty, but the issue of wear and osteolysis continue to be a problem, mostly for young adults. For this population varus rotational osteotomy still remains a viable alternative to total hip arthroplasty. The purpose of this prospective study was to describe the indications, the technique and the functional outcome of an isolated varus femoral osteotomy in 52 patients with hip dysplasia. We obtained very good results with a significant improvement of hip function and pain relief. We conclude that with appropriate selection of the patient the procedure may prevent or postpone the development of secondary osteoarthritis.     

Long-term results of valgus-extension femoral osteotomy for advanced osteoarthritis of the hip

We treated 31 hips in 30 patients with advanced osteoarthritis of the hip secondary to acetabular dysplasia, by valgus-extension femoral osteotomy. The mean follow-up was 12.7 years (10 to 17). Acetabuloplasty was added in ten severely dysplastic hips. In 28 hips, radiological widening of the joint space was seen three years after operation, but in 12 had narrowed again by ten years. Survivorship analysis showed that the rate of survival was 82% using the pain score as the index of failure, and 72% based on radiological findings at ten years. Better long-term results were obtained in hips which had an acetabular head index greater than 70% or a roof osteophyte more than 5 mm in length three years after operation. Acetabuloplasty should be added for the hip which is severely dysplastic and with a poorly developed roof osteophyte.     

Gait analysis following varus osteotomy of the femur for hip osteoarthritis

The purpose of this study was to evaluate differences in the gait patterns of healthy and osteoarthritic hips, and changes in these patterns after intertrochanteric varus osteotomy of the femur, in relation to the strength of the muscles around the hip joint. We measured the strength ratio of hip abductor muscles, temporal and distance factors, and pelvic movement, and carried out dynamic electromyography (EMG) in 24 women who underwent unilateral varus osteotomy of the femur for hip osteoarthritis (OA), 30 non-surgically-treated women with hip OA, and 54 healthy women. The stance phase time was shorter and the strength ratio of hip abductor muscles was lower in the operated patients than these values in the other two groups, changes in pelvic obliquity and tilt were smaller, and changes in the percent maximum voluntary contraction of the gluteus medius and tensor fascia latae muscles were greater than these values in the healthy subjects. This study showed the postoperative reappearance of the simulated conditions in the hip before varus osteotomy of the femur, providing evidence that the pelvis was horizontally maintained during walking due to the decreased stance phase time and increased performance of the hip abductor muscles achieved after this procedure. Received for publication on March 30, 1998; accepted on Sept. 28, 1998     

转子间内翻内移截骨术治疗Perthes病的远期效果

目的观察转子间内翻内移截骨术治疗Perthes病的远期疗效。方法对38例Perthes病患儿施行了转子间内翻内移截骨术,手术时年龄4～13岁,平均8岁10个月;Ⅱ期19例,Ⅲ期14例,Ⅳ期5例。平均随访7年(3～15年),根据临床表现和X线征象评定疗效,分析其远期效果。结果根据自拟的评定标准,优15例,良17例,可3例,差3例,总优良率84.2%;Ⅱ期患儿优良率94.7%,Ⅲ期85.7%,Ⅳ期40.0%。结论转子间内翻内移截骨术治疗Perthes病具有术式简单、损伤小、疗效良好等优点,值得推广应用。     

Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy

Introduction Inferior survival of cemented total hip arthroplasty has been reported after previous femoral osteotomy. The purpose of this study was to evaluate the long-term survival of uncemented stems after femoral osteotomy.Materials and methods Forty-eight hips in 45 patients had undergone conversion THA for a failed intertrochanteric osteotomy of the hip after a mean of 12 years (2–33 years). Mean time of follow-up was 11 years (5–15 years).Results At follow-up, two patients (three hips) had died, and one patient (one hip) was not located. Three patients (three hips) underwent femoral revision—one for infection and two for aseptic loosening of the stem. Survival of the stem was 94% at 10 years, and survival with femoral revision for aseptic loosening as an end point was 96%. The median Harris Hip Score at follow-up was 80 points. Radiolucent lines in Gruen zones 1 and 7 were present in 14 and 18% of hips, respectively. Radiolucencies in other zones were not detected. There was no radiographic evidence of femoral osteolysis, stress-shielding or loosening.Conclusion The results with this type of uncemented tapered titanium femoral component after proximal femoral osteotomy are encouraging and compare to those achieved in patients with regular femoral anatomy.     

Rotational acetabular osteotomy for the dysplastic hip

A circumacetabular osteotomy of the acetabulum was initially done at the University of Tokyo Hospital by one of us (H. T.) in 1968. This procedure, which rotates the acetabulum, was designed to correct a dysplastic acetabulum in adolescents and adults. The surgical exposure combines both an anterior and a posterior approach. Between 1974 and 1982 this operation was performed on 103 patients (120 hips) with acetabular dysplasia, some showing early degenerative arthritis. The forty-five hips (forty-one patients) that form the basis of this report were followed for three years to eight years and ten months (average, four years and six months). Thirty hips showed only acetabular dysplasia, and fifteen were in the early stage of degenerative arthritis. The ages of the patients at the time of operation ranged from eleven to forty-two years, the majority being in the second or third decade of life. All of the forty-five hips had a preoperative center-edge angle of 10 degrees or less, but most of them had a nearly normal value after surgery. In the majority of the hips either limp or pain with exertion, or both, had disappeared, and a satisfactory range of motion had been restored.     

Cementless total hip replacement after previous intertrochanteric valgus osteotomy for advanced osteoarthritis

We present a series of 30 uncemented total hip replacements performed between June 1985 and January 2002 with a mean follow-up of seven years (5 to 20) in 27 patients who had previously undergone a valgus intertrochanteric osteotomy. No further osteotomy was undertaken to enable hip replacement. We used a number of uncemented modular or monoblock femoral components, acetabular components and bearings. The patients were followed up clinically and radiologically. We report 100% survival of the femoral component. One acetabular component was revised at five years post-implantation for aseptic loosening. We noted cortical hypertrophy around the tip of the monoblock stems in six patients. We believe that modular femoral components should be used when undertaking total hip replacement in patients who have previously undergone valgus femoral osteotomy.     

Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31 degrees was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.     

Long-term results of cementless femoral reconstruction following intertrochanteric osteotomy

Purpose

The objective of this retrospective cohort study was to assess the long-term outcome of cementless femoral reconstruction in patients with previous intertrochanteric osteotomy (ITO).

Methods

We evaluated the clinical and radiographic results of a consecutive series of 45 patients (48 hips, mean age 50 years) who had undergone conversion hip replacement following ITO with a cementless, grit-blasted, double-tapered femoral component. Clinical outcome was determined using the Harris hip score. Stem survival for different end points was assessed using Kaplan-Meier survivorship analysis.

Results

At a mean follow-up of 20 (range, 16–24) years, 11 patients (12 hips) had died, and no patient was lost to follow-up. Six patients (six hips) underwent femoral revision, two for infection, three for aseptic loosening and one for periprosthetic fracture. Mean Harris hip score at final follow-up was 78 points (range, 23–100 points). Stem survival for all revisions was 89% (95%CI, 75–95) at 20 years, and survival for aseptic loosening was 93% (95%CI, 80–98).

Conclusions

The long-term results with this type of cementless femoral component in patients with previous intertrochanteric osteotomy are encouraging and compare well to those achieved in patients with normal femoral anatomy.     

Distal femoral varus osteotomy for osteoarthritis of the knee

BACKGROUND: Distal femoral varus osteotomy is a procedure that is performed for the treatment of lateral-compartment osteoarthritis of the knee as well as for correction of the associated valgus deformity. However, its role remains controversial and its efficacy in the treatment of associated patellofemoral arthritis has not been well studied. The purpose of the present study was to evaluate the outcome after distal femoral osteotomy performed for the treatment of painful genu valgum and to assess the influence of patellofemoral arthritis on the results. METHODS: Thirty patients (thirty knees) were managed with distal femoral varus osteotomy for the treatment of noninflammatory lateral-compartment arthritis of the knee associated with a valgus deformity. Twelve knees had isolated lateral-compartment arthritis, ten had mild-to-moderate degenerative changes in the other two compartments, and eight knees had severe patellofemoral arthritis in addition to lateral-compartment disease. The osteotomy site was fixed with a 90 degrees blade-plate. After a mean duration of follow-up of ninety-nine months, all patients were evaluated with use of the Hospital for Special Surgery knee-rating system and a physical examination. RESULTS: At the time of the most recent follow-up, twenty-five patients (83%) had a satisfactory result and two had a fair result according to the Hospital for Special Surgery rating system. The remaining three patients had had a conversion to a total knee arthroplasty. With conversion to total knee arthroplasty as the end point, the cumulative ten-year survival rate for all patients was 87% (95% confidence interval, 69% to 100%). Improvement in patellar tracking, which persisted at the time of the latest follow-up, was observed in seven of the eight knees with associated severe patellofemoral arthritis. CONCLUSIONS: Distal femoral varus osteotomy with blade-plate fixation can be a reliable procedure for the treatment of lateral-compartment osteoarthritis of the knee associated with valgus deformity. The result of the osteotomy does not appear to be affected by the presence of severe patellofemoral arthritis.     

髂骨与转子间联合截骨术治疗Perthe’s病

目的探讨Slter骨盆截骨与转子间内翻联合截骨术治疗Pcrthe’s病的疗效和影响因素。方法对9例有股骨头骨骺塌陷和包容不良合并半脱位的5～13岁(平均7.4岁)患儿,同时完成Salter骨盆截骨和转子间内翻联合截骨术,利用转子间取出的楔形骨块行髂骨截骨间隙内嵌入植骨,6例双截骨端用双克氏针交叉固定,3例髂骨截骨端双克氏针交叉固定,转子间截骨端用90°小钢板固定。结果术后随访4～8年,全部顺利完成骨愈合,X线形态测量包容良好,头基本恢复圆形,临床Harri’s评分平均术前78分改善到术后随访时的98分,取得良好的治疗效果。结论Slter骨盆截骨与转子间内翻联合截骨对Perthe’s病的扁平化后遗症和继发性髋臼指数增高的防止效果满意,对年龄小、病程短、髋关节形态明显异常者矫治效果更好。     

髂骨与转子间联合截骨术治疗Perthe''''s病

目的探讨Slter骨盆截骨与转子间内翻联合截骨术治疗Pcrthe's病的疗效和影响因素.方法对9例有股骨头骨骺塌陷和包容不良合并半脱位的5～13岁(平均7.4岁)患儿,同时完成Salter骨盆截骨和转子间内翻联合截骨术,利用转子间取出的楔形骨块行髂骨截骨间隙内嵌入植骨,6例双截骨端用双克氏针交叉固定,3例髂骨截骨端双克氏针交叉固定,转子间截骨端用90°小钢板固定.结果术后随访4～8年,全部顺利完成骨愈合,X线形态测量包容良好,头基本恢复圆形,临床Harri's评分平均术前78分改善到术后随访时的98分,取得良好的治疗效果.结论Slter骨盆截骨与转子间内翻联合截骨对Perthe's病的扁平化后遗症和继发性髋臼指数增高的防止效果满意,对年龄小、病程短、髋关节形态明显异常者矫治效果更好.     

Valgus-extension osteotomy for osteoarthritis of the hip. Indications and long-term results

We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigné scale. Better results were obtained in patients under 40 years of age with unilateral involvement and a mechanical (secondary) aetiology. An elliptical femoral head, minimal subluxation and an adequate pre-operative range of motion were also favourable. There was radiographic evidence of regression of the arthritic changes in 39% of the hips at final review. Valgus-extension osteotomy is effective for secondary osteoarthritis of the hip in selected younger patients, but not for those with primary hip disease or a poor range of movement.     

Long-term results of high tibial osteotomy for medial osteoarthritis of the knee

We reviewed retrospectively the results in patients who had undergone one hundred and four high tibial lateral osteotomies. The operations were all performed between 1985 and 1993. Each one of fifty men and forty nine women demonstrated a varus deformity of the knee with a coexistent medial osteoarthritis. Results were reviewed in 49 patients (62 knees) with an average follow-up of 10.2 years (range 6-14 years). Of the remaining 42 patients, 8 were lost to follow-up, 10 had died, and 24 were subsequently treated with total knee arthroplasty at an average 4.7 years after having had a high tibial osteotomy. Clinical results were evaluated using the Hospital for Special Surgery Score (HSS) and the Knee Society Score. Radiographs were systematically analysed to evaluate osteoarthritis and leg axis. Forty four (90 per cent) of the forty nine patients stated the results met their expectations and given the same circumstances, they would have the operation once again. In these patients the knee score results were excellent. The same patients had excellent HSS and Knee Society Scores. Five patients (10 per cent) had a poor result and twenty four patients were treated later by total knee arthroplasty because of pain. The following factors set these patients apart from those with more favorable results: previous arthroscopic debridement, obesity, lateral knee osteoarthritis, insufficient valgus correction, and an age of more than 55 years. High tibial valgus osteotomy provides good pain relief and improved function in carefully selected patients. Our results support this conclusion.