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Long-term results of valgus osteotomy for terminal-stage osteoarthritis of the hip

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Pauwels’ femoral osteotomy is a classical and joint-preserving method for osteoarthritis of the hip caused by acetabular dysplasia and/or subluxation. However, its application for terminal-stage osteoarthritis of the hip, and the long-term results, have not yet been reported. We herein aim to investigate the long-term results of valgus osteotomy for terminal-stage osteoarthritis of the hip.

Methods

Eighty-two hips of 75 patients (74 women and 1 man, mean age: 48.1 years) classified as having terminal-stage osteoarthritis by Kellgren and Laurence were indicated for valgus osteotomy from 1984 to 1993. Sixty-three hips of 57 patients were followed for more than 20 years (mean: 298 months). Follow-up rate was 77%.

Results

Preoperative mean hip score (Harris Hip Score) was 46.4 points. Thirty-two hips were later converted to total hip arthroplasty (THA) (mean: 185 months after surgery). Of the hips without conversion to THA, 31 hips scored 72.8 points on average, and 21 hips scored 70 or more points at the final follow-up. Kaplan–Meier survivorship analysis revealed that 40% of the hips, classified as non-atrophic type (according to Bombelli’s classification) at the time of operation, maintained their joint space width for 20 years (endpoint: less than 1 mm at the weight-bearing segment, i.e., recurrence of osteoarthritis) and also revealed that 60% of the hips were not converted for 20 years after the initial operation (endpoint: conversion to THA). Cox’s proportional hazard model revealed that those with the atrophic type had a hazard risk 24 times greater than those with the non-atrophic type of osteoarthritis.

Conclusion

This is the first report of the long-term results of osteotomy for terminal-stage osteoarthritis of the hip showing satisfactory results with a lengthy follow-up period. Pauwels’ valgus femoral osteotomy for terminal-stage osteoarthritis, excluding atrophic type, could be an acceptable alternative to THA.

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Acknowledgements

I am deeply grateful to the late Professor Ryozo Ueno and thank him for introducing me to Pauwels’ osteotomies and concepts. I am also grateful to Professor Ken Iwata, Kagawa University Medical School for conducting the clinical survey.

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  1. Department of Orthopaedic Surgery, Osaka Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka City, Osaka, 530-0021, Japan

    Suguru Ohsawa

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Correspondence to Suguru Ohsawa.

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Ohsawa, S. Long-term results of valgus osteotomy for terminal-stage osteoarthritis of the hip. Arch Orthop Trauma Surg 137, 19–26 (2017). https://doi.org/10.1007/s00402-016-2590-x

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