Rotational acetabular osteotomy for advanced osteoarthritis secondary to developmental dysplasia of the hip

We evaluated the results of rotational acetabular osteotomy in 44 hips (42 patients) with advanced osteoarthritis secondary to developmental dysplasia. The mean age of the patients at surgery was 43.4 years (30 to 59) and the mean follow-up was 12.1 years (8 to 19). The mean Merle d'Aubigné clinical score improved from 10.8 points (8 to 15) pre-operatively to 13.5 points (6 to 18) at follow-up. Radiologically, this procedure produced adequate improvement regarding cover of the femoral head. At follow-up, the osteoarthritic stage assessed using the Japanese Orthopaedic Association grading, was improved in 11 hips (25%), unchanged in 22 (50%) and had progressed in 11 (25%). The mean pre-operative roundness index of the femoral head was significantly different in the 33 hips which had improved or maintained their osteoarthritic stage compared with the 11 which had progressed (53.7% vs 63.7%; p < 0.001). Osteoarthritis with a round femoral head is considered to be an indication for rotational acetabular osteotomy, even in advanced stages of the disease.     

Rotational acetabular osteotomy for advanced osteoarthritis of the hip joint with acetabular dysplasia

Between August 1986 and July 1997, we performed rotational acetabular osteotomy (RAO) according to the methods of Ninomiya and Tagawa in 161 patients (179 hips). Among them, 63 patients (68 hips) had advanced osteoarthritis. We assessed the outcome at a mean of 12 years after rotational acetabular osteotomy was performed for the treatment of advanced osteoarthritis in a series of patients with acetabular dysplasia. Eleven patients did not return for final follow-up and were excluded from the study, leaving 52 patients (57 hips) for analysis. The mean Merle d’Aubigné clinical score improved from 12.6 points (range 9–16) preoperatively to 14.3 points (range 7–18) postoperatively (p < 0.002), mainly because of increased scores for pain. At final follow-up, 50 of the 57 hips were still functioning. The results of rotational acetabular osteotomy for correction of advanced osteoarthritis in adults with acetabular dysplasia were satisfactory after a mean of 12.2 years.     

Rotational acetabular osteotomy for advanced osteoarthrosis secondary to dysplasia of the hip

Clinical and radiological studies were done on the results of rotational acetabular osteotomy for advanced osteoarthrosis secondary to dysplasia of 29 adult hips followed up for 6 to 11 years postoperatively (mean 8 years). Clinical evaluation by Merle d'Aubigne and Postel's system showed improvement from a preoperative mean of 12.8 to a follow-up mean of 14.8, with aggravation being observed in 8 joints. Radiologically, this procedure produced adequated improvement regarding femoral head coverage, but improvement in joint congruency could not necessarily be obtained due to joint deformity and progression of arthrosis, with aggravation of joint congruency being observed in 6 joints. The most important factor influencing the postoperative results of this procedure was postoperative joint congruency. If the postoperative joint congruency is satisfactory, with the joint congruent index being more than 6.0, progression of arthrosis can be prevented in the long term by this procedure, even in advanced cases.     

髋臼旋转截骨术治疗早中期髋关节发育不良

目的探讨髋臼旋转截骨术治疗早中期髋关节发育不良的手术技术要点及中期疗效。方法2000年5月至2006年5月对12例（14髋）早、中期髋关节发育不良患者进行了髋臼旋转截骨术,所有患者均为女性,手术时年龄13—46岁,平均28．9岁。随访时间3．1—9．1年,平均6．0年。术前、术后及随访时X线片上测量CE角,髋臼顶角及头外移指数。Harris评分判断髋关节功能。手术采用Oilier外侧“U”形入路,股骨大转子截骨显露。术后未行外固定。结果患者疼痛症状得到明显改善,Harris评分术前72分,术后91分（P〈0．001）。CE角术前0．9°,术后27°（P〈0．001）;髋臼顶角术前为29°,术后5°;头外移指数术前为0．68,术后0．65。所有病例截骨块及股骨大转子截骨处愈合良好。结论Oilier外侧“U”形入路行髋臼旋转截骨术髋臼缘显露充分;治疗早中期髋关节发育不良可以缓解疼痛,延缓骨关节炎的进展速度,中期随访疗效满意。     

Rotational acetabular osteotomy with excision of the capital drop for advanced osteoarthritis secondary to developmental dysplasia of the hip

Introduction  Advanced-stage osteoarthritis may occasionally be associated with capital drop of the femoral head. In such cases, excision of the capital drop is performed to obtain good congruency with sufficient coverage of the femoral head by rotational acetabular osteotomy (RAO). In the present study, we examined the outcome of RAO with excision of the capital drop. Materials and methods  Rotational acetabular osteotomy (RAO) with excision of the capital drop was performed in 17 hips of 16 patients with a mean follow-up of 12.6 years (excision group), while only RAO was performed in 42 hips of 41 patients with a mean follow-up of 12.3 years (non-excision group). All 57 patients indicated radiographic evidence of advanced-stage osteoarthritis. Clinical follow-up was performed using the Merle d’Aubigné and Postel system. The clinical and radiological results were compared between the two groups. Results  The mean Merle d’Aubigne and Postel’s total hip-joint scores at follow up significantly (p < 0.001) improved compared with the mean pre-operative scores only in the non-excision group. While the numbers of hips in excision group (17 hips) showing progressive and non-progressive osteoarthritic changes were 10 and 7, those in the non-excision group (42 hips) were 11 and 20, respectively. Although none (0/17) in the excision group showed any improvement in osteoarthritic stage at follow up, 11 of 42 hips indicated a favorable outcome in the non-excision group. There were significantly (p = 0.0077) higher improvements in osteoarthritis stage in the non-excision than excision group. Three patients each of the excision group (18%) and non-excision group (7%) underwent total hip arthroplasty during the follow-up period. Conclusion  Excision of capital drop of the femoral head is not a useful adjunct to the RAO procedure for the treatment of advanced osteoarthritis. Based on results from a previous study, Chiari pelvic osteotomy may serve as a more favorable alternative. No benefits in any form have been received or will be received from a commercial party related directly or the subject of this article. The study did not receive institutional review board approval because our institution does not require such approval for retrospective studies.     

Transtrochanteric valgus osteotomy for the treatment of osteoarthritis of the hip secondary to acetabular dysplasia

Our study describes the mid-term clinical results of the use of transtrochanteric valgus osteotomy (TVO) for the treatment of osteoarthritis of the hip secondary to acetabular dysplasia. The operation included valgus displacement at the level of the lesser trochanter, and lateral displacement of the greater trochanter by inserting a wedge of bone. We reviewed 70 hips. The mean age of the patients at operation was 44 years (14 to 59). Most (90%) had advanced osteoarthritis. The scores for pain and gait had improved significantly at a mean follow-up of 9.4 years. The rate of survival until an endpoint of a further operation during a follow-up of ten years was 82%. The survival rate was 95% in patients with unilateral involvement who were less than 50 years of age at operation. TVO is a useful form of treatment for advanced osteoarthritis of the hip, particularly in young patients with unilateral disease.     

髋臼旋转截骨术治疗髋臼发育不良

目的探讨髋臼旋转截骨术治疗髋臼发育不良的疗效。方法应用髋臼旋转截骨术治疗髋臼发育不良16例（18髋）,截骨线距臼周缘2 cm,做穹隆状截骨,凿断后再用弧度骨凿将髋臼向前外下方旋转。髋臼矫正到较正常位置后,截骨间隙呈楔形状,用类似间隙大小的楔形同种异体骨块嵌入,并用可注射状人工骨填满间隙,最后用2枚可吸收螺钉固定。测定并比较术前和术后JOA评分、CE角和Sharp角。结果16例均获随访,时间442个月。术后摄片髋关节复位位置好,股骨头及髋臼形状基本正常。髋臼旋转截骨及植入骨块2个月后骨性愈合,6个月后髋关节功能恢复正常17髋,较差1髋,无患髋的骨性关节炎病变继续恶化。JOA评分：术前为75.2分±3.1分,术后为93.5分±3.5分;CE角：术前为15.8°±1.3°,术后为33.4°±1.7°;Sharp角：术前为47.3°±2.5°,术后为29.8°±2.1°。JOA评分术后增加18.3分;CE角增加17.6°,Sharp角减少17.5°,差异有统计学意义（P〈0.05）。结论髋臼旋转截骨术可矫正头臼间异常的匹配关系,使疼痛得到缓解,并使骨性关节炎的过程得到有效遏制,是治疗髋臼发育不良合并早、中期骨性关节炎的理想术式。     

Rotational acetabular osteotomy in congenital dysplasia of the hip

Summary Rotational acetabular osteotomy was carried out in 127 patients (147 hips) with acetabular dysplasia, some of whom showed early or progressive degenerative changes. Complications occurring during and after operation were transient lesions of the lateral femoral cutaneous nerve in 20 patients, of the femoral nerve in 2, fracture of the acetabulum in 1, inadequate rotation of the acetabulum in 11, and infection in 3 patients. Later complications were breakage of Kirschner wires in 3, ectopic bone formation in 2 and acute chondrolysis in 3 patients. Sixty-six patients (69 hips) were followed for an average of 5 years and 4 months, and in most of them satisfactory results were achieved in spite of these complications.

---

Résumé Une ostéotomie cotyloïdienne de rotation a été réalisée 147 fois sur 127 malades porteurs d'une dysplasie du cotyle, certains d'entre eux présentaient des lesions dégénératives débutantes ou évolutives. Les complications per ei post-opératoires suivantes ont été observées: 20 atteintes transitoires du nerf fémoro-cutané, 2 du nerf crural, 1 fracture du cotyle, 11 rotations incorrectes du cotyle, et 3 infections. Les complications tardives ont été 3 ruptures des broches de Kirschner, 2 ossifications périarticulaires et 3 chondrolyses aigües. Soixante-six opérés (69 hanches) ont été suivis en moyenne pendant 5 ans et 4 mois, chez la plupart d'entre eux des résultats satisfaisants ont été obtenus malgré ces diverses complications.

     

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.     

Rotational acetabular osteotomy for hip dysplasia: spontaneous medial enlargement of the acetabulum

We followed 56 patients (63 joints) who had undergone rotational acetabular osteotomy (RAOs) between 1987 and 1993, mean 7 (5-12) years. The Merle d'Aubigné score increased by 15 points or more in 59 and decreased in 4 hips. The arthrosis progressed in 5 joints. In about 2/3 of the cases, we observed some medial and/or lateral expansion of the subchondral bone in the acetabulum 3 years postoperatively, suggesting enlargement of the load-bearing area.     

Rotational acetabular osteotomy for hip dysplasia: Spontaneous medial enlargement of the acetabulum

We followed 56 patients (63 joints) who had undergone rotational acetabular osteotomy (RAOs) between 1987 and 1993, mean 7 (5-12) years. The Merle d'Aubigné score increased by 15 points or more in 59 and decreased in 4 hips. The arthrosis progressed in 5 joints. In about 2/3 of the cases, we observed some medial and/or lateral expansion of the subchondral bone in the acetabulum 3 years postoperatively, suggesting enlargement of the load-bearing area.     

先天性髋臼发育不良继发骨性关节炎的外科治疗

目的 探讨Zweymuller 型人工全髋关节假体置换治疗先天性髋臼发育不良继发髋关节骨性关节炎的有效性。方法 应用Zweymuller型人工全髋关节假体,对29例32个先天性髋臼发育不良继发髋关节骨性关节炎患者行全髋关节置换（THR）。患者全部为女性,单侧26例,双侧3例。Perner分型度17例,19个髋,Ⅱ度7例,7个,Ⅲ度4例,5个髋,Ⅳ度1例,1个髋。平均随访27．5个月,术前Harris评分最高59分,最低25分,平均44．5分.结果所有患者髋关节疼痛完全消失,关节活动度增加,Harris评分最高97分,最低63分,平均85分。结论 特殊设计的Zweymuller型人工全髋关节假体置换初期稳定,手术不需大块植骨和骨水泥,初期随访效果满意。     

Rotational acetabular osteotomy for acetabular dysplasia of the hip with a giant acetabular bone cyst: a case report

In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.     

Triple pelvic osteotomy as treatment for osteoarthritis secondary to developmental dysplasia of the hip

Joint-preserving osteotomies are an established treatment for adult hip pain secondary to developmental dysplasia of the hip. However, their value for advanced osteoarthritis is unclear. Therefore this study addresses the question of long-term results of triple pelvic osteotomy in patients with second grade osteoarthritis. Thirty-two patients with second grade osteoarthritis secondary to developmental dysplasia of the hip before triple pelvic osteotomy were clinically and radiographically assessed 11.5 years postoperatively. Five patients required conversion to total hip replacement. Kaplan-Meier survivorship analysis predicted a survival rate of 85.3%. The mean Harris hip score increased significantly with more than 56% good or very good results. A preoperative BMI > 25 and Harris hip score < 70 resulted in worse outcome or early conversion into total hip arthroplasty. The results indicate that developmental dysplasia of the hip even in second grade osteoarthritis can be treated with triple pelvic osteotomy.     

Chiari pelvic osteotomy for advanced osteoarthritis in patients with hip dysplasia

BACKGROUND: It is not clear whether a Chiari pelvic osteotomy performed for the treatment of advanced osteoarthritis can delay the need for total hip arthroplasty. We present the mid-term results of the Chiari pelvic osteotomy performed for the treatment of T?nnis grade-3 osteoarthritis (large cysts, severe narrowing of the joint space, or severe deformity or necrosis of the head with extensive osteophyte formation), with a particular focus on whether this procedure can delay the need for total hip arthroplasty. METHODS: We followed thirty-two hips in thirty-one patients with T?nnis grade-3 osteoarthritis who had refused total hip arthroplasty and had been treated with a Chiari pelvic osteotomy. The mean age at the time of surgery was 35.2 years. The mean duration of follow-up was 11.2 years, at which time clinical evaluation with the Harris hip score and radiographic evaluation were performed. RESULTS: The average Harris hip score improved from 52 points preoperatively to 77 points at the time of follow-up; the average pain score improved from 20 to 31 points. Three hips with a hip score of <70 points required total hip arthroplasty. With a hip score of <70 points as the end point, the cumulative rate of survival at ten years was 72%. The clinical outcome was significantly influenced by the preoperative center-edge angle (p = 0.004), the preoperative acetabular head index (p = 0.039), achievement of the appropriate osteotomy level (p = 0.011), and superior migration (p = 0.009) and lateral migration (p = 0.026) of the femoral head. CONCLUSIONS: Although the clinical results were inferior to those of total hip arthroplasty, Chiari pelvic osteotomy may be an option for young patients with advanced osteoarthritis who prefer a joint-conserving procedure to total hip arthroplasty and accept a clinical outcome that is predicted to be less optimal than that of total hip arthroplasty. Moderate dysplasia and moderate subluxation without complete obliteration of the joint space and a preoperative center-edge angle of at least -10 degrees are desirable selection criteria.     

Rotational acetabular osteotomy for hip dysplasia: 61 hips followed for 8-15 years

We operated on 54 patients (61 joints) with rotational acetabular osteotomy (RAO) due to dysplasia of the hip with pre- or early-stage osteoarthritis/arthrosis. The mean follow-up was 11 (8-15) years. The Merle d'Aubigné median score increased from 14 to 15. In 2 patients (2 joints), the score decreased from 15 to 13. Progression of arthrosis was seen in 6 joints on the radiographs at follow-up. Kaplan-Meier survivorship analysis predicted an 89% (95% confidence interval 80-99) prevention of worsening of arthrosis at 10 years. Postoperative joint congruency was a risk factor for progression of arthrosis.     

Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia. Indications and long-term results

Of 142 Chiari pelvic osteotomies for osteoarthritis in dysplastic hips, most performed by Chiari himself, we were able to review 82 and obtain information about 18 by questionnaire. All patients were over 30 years of age at operation; follow-up averaged 15.5 years. Twenty hips had undergone secondary total hip replacement. The outcome was good in 75%, fair in 9% and poor in 16%. High osteotomies all gave good results, and the result also depended on adequate medialisation. Statistics were worse for patients over 44 years of age at the time of operation. For osteoarthritis secondary to hip dysplasia, the Chiari pelvic osteotomy is an alternative procedure to early hip replacement. In contrast to intertrochanteric osteotomy, it has the advantage of facilitating the implantation of an acetabular prosthesis should arthroplasty become necessary at a later stage.     

Rotational acetabular osteotomy for acetabular dysplasia. A follow-up for more than ten years

Between 1986 and 1990, we carried out 55 rotational acetabular osteotomies in 54 patients with acetabular dysplasia. Five hips were lost to follow-up. Of the 50 remaining, the degenerative changes were classified according to the criteria of T?nnis as grade 0 in 23, grade 1 in 16 and grade 2 in 11. The mean age of the three men and 46 women at the time of operation was 31.8 years (13 to 53). The mean follow-up was 137 months (120 to 174). At the most recent follow-up, 48 patients had satisfactory relief from pain. There was a slight decrease in the range of movement, particularly of flexion, in 18 hips. Radiologically, all osteotomies had united satisfactorily. There was radiological evidence of improvement in degenerative changes in 13 hips (5 grade 1 and 8 grade 2). Ten deteriorated (5 grade 0, 3 grade 1, and 2 grade 2) and one required total hip arthroplasty ten years after osteotomy. The osteoarthritis in the two hips with an associated valgus osteotomy progressed. The changes in radiological indices such as the centre-edge angle, acetabular femoral head index, acetabular root obliquity and horizontal or vertical displacement of the femoral head showed no statistical difference (unpaired Student's t-test) between the patients with radiological progression and those with and without improvement.     

Crossover sign after rotational acetabular osteotomy for dysplasia of the hip

Background  

This study was performed to evaluate whether the radiographic crossover sign influences the painful femoroacetabular impingement or the radiographic progression of osteoarthritis after rotational acetabular osteotomy (RAO).     

先天性髋关节发育不良伴继发性骨性关节炎的病理特点及全髋关节置换术近期疗效观察

[目的]探讨非骨水泥假体的全髋置换术治疗成人先天性髋臼发育不良伴继发性骨关节炎的经验及评价全髋置换术后的近期疗效.[方法]自2000年3月至2007年3月,对25例30髋成人先天性髋臼发育不良伴继发性骨关节炎的患者进行了非骨水泥假体的全髋置换术,其中男5例,女20例;年龄35～55岁,平均45岁,双侧5例,单侧20例.主要症状为疼痛及跛行.根据Hartofilakidis分类方法,半脱位21髋,高位脱位9髋.[结果]经8个月～7年平均3年9个月的随访.Harris评分由术前36.09恢复到术后的88.21.所有病人患髋疼痛基本消失,可以长时间行走,X线片示人工髋关节位置良好,假体无松动及明显下沉迹象,生活自理并恢复日常工作.[结论]非骨水泥假体全髋关节置换术是治疗成人先天性髋臼发育不良伴继发性骨关节炎的有效方法.选择合适的假体,髋臼的加深及恰当的髋臼缺损处骨移植是手术成功的关键.