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.
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Haverkamp, D., Marti, R.K. Bilateral varus osteotomies in hip deformities: are early interventions superior?. International Orthopaedics (SICOT) 31, 185–191 (2007). https://doi.org/10.1007/s00264-006-0147-2
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DOI: https://doi.org/10.1007/s00264-006-0147-2