International Orthopaedics

, Volume 31, Issue 2, pp 185–191 | Cite as

Bilateral varus osteotomies in hip deformities: are early interventions superior?

A long-term follow-up
Original Paper

Abstract

Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but there were only minor to no complaints. We advised and performed an early osteotomy on these hips. On radiological evaluation, an average Sharp angle of 42.2 degrees and an average CCD of 142 degrees was present. During an average follow-up period of 19.9 years (range 15.0–25.9), 14 hips were converted to THR after the primary osteotomy, whereas there were only 6 after the early osteotomy (chi-square P<0.05). Using a Pearson correlation analysis, the age, preoperative grade of OA, preoperative Merle d’Aubigne score and excessive femoral anteversion were significantly correlated with the outcome. Our results show that the effect of an early, more prophylactic varus osteotomy in patients with a coxa valga with excessive femoral anteversion and acetabular dysplasia can be superior to the results achieved when surgery is postponed until the complaints and arthrosis have become more severe.

Résumé

Le Coxa valga (avec ou sans antéversion fémorale excessive) associée à une dysplasie cotyloïdienne est une cause parfaitement connue de coxarthrose précoce. Beaucoup d’auteurs ont conclu que les meilleurs résultats d’une ostéotomie pouvaient être obtenus si l’on intervenait précocement. Dans cette étude, nous avons étudié les dossiers de 26 patients qui présentaient une déformation des hanches symétrique et pour laquelle nous avons réalisé une ostéotomie, uniquement sur la hanche symptomatique. Radiologiquement, il existait sur ces hanches un angle de Sharp de 42,2° et un angle cervical CCD de 142° en moyenne. Après une période moyenne de 19 ans (15 à 25,9 ans), 14 hanches ont été converties précocement en prothèses totales après l’ostéotomie. Nous avons corrélé pour l’analyse des résultats l’âge, le stade de l’arthrose, le score de Merle d’Aubigné préopératoire, le degré d’antéversion. Les résultats montrent que les effets d’une ostéotomie prophylactique précoce, chez les patients présentant une coxa valga avec antéversion fémorale excessive et dysplasie acétabulaire sont supérieurs à ceux obtenus si l’intervention chirurgicale a lieu après l’apparition des premiers signes. Dans ces cas là l’évolution se produit vers une coxarthrose sévère.

References

  1. 1.
    Aronson J (1986) Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect 35:119–128PubMedGoogle Scholar
  2. 2.
    Bombelli R, Aronson J (1984) Biomechanical classification of osteoarthritis of the hip with special reference to the treatment techniques and results. In: Schatzker J (ed) The intertrochanteric osteotomy. Springer, Berlin Heidelberg New York pp 67–134Google Scholar
  3. 3.
    Ganz R, Leunig M (2002) Osteotomy and the dysplastic hip: the Bernese experience. Orthopedics 25:945–946PubMedGoogle Scholar
  4. 4.
    Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 20–33Google Scholar
  5. 5.
    Heyman CH, Herndon CH (1950) Legg-Perthes disease; a method for the measurement of the roentgenographic result. J. Bone Joint Surg Am 32:767–778PubMedGoogle Scholar
  6. 6.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRefGoogle Scholar
  7. 7.
    Klaue K, Durnin CW, Ganz R (1991) The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 73:423–429PubMedGoogle Scholar
  8. 8.
    Maquet P (1989) Osteotomies of the proximal femur. In: Reynolds D, Freeman M (eds) Osteoarthritis in the young adult hip, options for surgical management. Churchill LivingstoneGoogle Scholar
  9. 9.
    McMurray TP (1990) Osteo-arthritis of the hip joint. 1939. Clin Orthop Relat Res 3–10Google Scholar
  10. 10.
    Merle dR (1953) Functional results of arthroplasty of the hip. Acta Orthop Belg 19:81–103Google Scholar
  11. 11.
    Millis MB, Kim YJ (2002) Rationale of osteotomy and related procedures for hip preservation: a review. Clin Orthop Relat Res 108–121Google Scholar
  12. 12.
    Millis MB, Murphy SB, Poss R (1996) Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect 45:209–226PubMedGoogle Scholar
  13. 13.
    Millis MB, Poss R, Murphy SB (1992) Osteotomies of the hip in the prevention and treatment of osteoarthritis. Instr Course Lect 41:145–154PubMedGoogle Scholar
  14. 14.
    Muller ME (1971) Die Huftnahen Femurosteotomien. Georg Thieme Verlag, Stuttgart pp 140–158Google Scholar
  15. 15.
    Muller ME (1984) Intertrochanteric Osteotomy: Indication, preoperative planning, technique. In: Schatzker J (ed) The intertrochanteric osteotomy. Springer, Berlin Heidelberg New York, pp 25–66Google Scholar
  16. 16.
    Reigstad A, Gronmark T (1984) Osteoarthritis of the hip treated by intertrochanteric osteotomy. A long-term follow-up. J Bone Joint Surg Am 66:1–6PubMedGoogle Scholar
  17. 17.
    Santore RF, Dabezies EJ Jr (1995) Femoral osteotomy for secondary arthritis of the hip in young adults. Can J Surg 38(Suppl 1):S33–S38PubMedGoogle Scholar
  18. 18.
    Sharp IK (1961) Acetabular dysplasia, The acetabular angle. J Bone Joint Surg 43-B:268–273Google Scholar
  19. 19.
    Tonnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 39–47Google Scholar
  20. 20.
    Tonnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770PubMedGoogle Scholar
  21. 21.
    Weisl H (1980) Intertrochanteric osteotomy for osteoarthritis. A long-term follow-up. J Bone Joint Surg Br 62-B:37–42PubMedGoogle Scholar
  22. 22.
    Wiberg G (1939) The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand 83(Suppl 58):7–38Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Department of Orthopaedic SurgeryAcademic Medical CentreAmsterdamThe Netherlands

Personalised recommendations