Long-term results of a modified Spitzy shelf operation for developmental dysplasia of the hip in adults and adolescents

  • Hidetatsu TanakaEmail author
  • Daisuke Chiba
  • Yu Mori
  • Yoshiyuki Kuwahara
  • Kazuyoshi Baba
  • Norikazu Yamada
  • Genji Fujii
  • Eiji Itoi
Original Article • HIP - PELVIS


The purpose of the current study was to retrospectively evaluate the long-term outcome of our shelf operation for acetabular dysplasia in adults and adolescents. We evaluated the outcome of shelf operation performed in 35 hips of 32 patients with acetabular dysplasia between 1978 and 1996. The mean age at the time of surgery was 30.6 years, and the mean follow-up period was 25.9 years. The pre-operative stage of osteoarthritis was Tönnis grade 0 in 12 hips and grade 1 in 23 hips. Clinical evaluation using the JOA hip score showed more than 85 of 100 points over 25 years. Radiologically, acetabular index was significantly improved after operation. Osteoarthritis deteriorated to grade 3 in 8 of 35 hips (23%) at an average 17.1 years, and accordingly 3 of those 8 hips were converted to THA. The shelf height was significantly higher in those which advanced to grade 3 than in those which did not. There were no significant differences in mean sharp angle, CE angle, AHI, and roundness index. Mean survival was 74% with grade 3 as the endpoint and 72% with THA conversion as the endpoint. Shelf operation provides satisfactory long-term outcome in adults and adolescents with acetabular dysplasia. Higher location of the shelf is a risk factor for advancement of osteoarthritis, whereas sphericity of the femoral head does not affect the long-term results. Further studies are needed to clarify the risk factors about OA progression among the patients with acetabular dysplasia, like as the assessment of three-dimensional morphology of hip joints.


Shelf operation Long-term results Acetabular dysplasia Shelf height Roundness index 


Compliance with ethical standards

Conflict of interest

No conflict of interest was declared by all authors.


  1. 1.
    Jingushi S, Ohfuji S, Sofue M, Hirota Y, Itoman M, Matsumoto T, Hamada Y, Shindo H, Takatori Y, Yamada H, Yasunaga Y, Ito H, Mori S, Owan I, Fujii G, Ohashi H, Iwamoto Y, Miyanishi K, Iga T, Takahira N, Sugimori T, Sugiyama H, Okano K, Karita T, Ando K, Hamaki T, Hirayama T, Iwata K, Nakasone S, Matsuura M, Mawatari T (2010) Multiinstitutional epidemiological study regarding osteoarthritis of the hip in Japan. J Orthop Sci 15(5):626–631. CrossRefPubMedGoogle Scholar
  2. 2.
    Jacobsen S, Sonne-Holm S (2005) Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey. Rheumatol (Oxf) 44(2):211–218. CrossRefGoogle Scholar
  3. 3.
    Reijman M, Hazes JM, Pols HA, Koes BW, Bierma-Zeinstra SM (2005) Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study. Arthritis Rheum 52(3):787–793. CrossRefPubMedGoogle Scholar
  4. 4.
    Chiari K (1974) Medial displacement osteotomy of the pelvis. Clin Orthop Relat Res 98: 55–71. Pubmed:
  5. 5.
    Ninomiya S, Tagawa H (1984) Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am 66(3): 430–436. Pubmed:
  6. 6.
    Ganz R (1988) A new periacetabular osteotomy for the treatment of hip dysplasia. Clin Orthop Relat Res 232:26–36. Pubmed:
  7. 7.
    Konig F (1981) Osteoplastische Behandelung der congenital Huftgelenkluxation. Verh Deutsch Ges Chir 20:75–80Google Scholar
  8. 8.
    Spitzy H (1933) Kunstliche Pfannendachbildung: Benutzung von Knochenbolzen zur temporären Fixation. Z Orthop Chir 58:470–486Google Scholar
  9. 9.
    Lance P (1925) Herstellung eines osteoplastischen Pfannen daches bei angeborenen Verrenkung und Subluxationen der Hufte. Presse Med 945Google Scholar
  10. 10.
    Bartonicek J, Vavra J, Chochola A (2012) Bosworth hip shelf arthroplasty in adult dysplastic hips: ten to twenty three year results. Int Orthop 36(12):2425–2431. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hamanishi C, Tanaka S, Yamamuro T (1992) The Spitzy shelf operation for the dysplastic hip. Retrospective 10 (5–25) year study of 124 cases. Acta Orthop Scand 63(3): 273–277. Pubmed:
  12. 12.
    Migaud H, Spiers A, Gougeon F, Pierchon F, Fontaine C, Duquennoy A (1995) Outcome of hip shelf arthroplasty in adults after a minimum of 15 years of follow-up. Long term results and analysis of failures of 56 dysplastic hips. Rev Chir Orthop Reparatrice Appar Mot 81(8):716–723. Pubmed:
  13. 13.
    Hirose S, Otsuka H, Morishima T, Sato K (2011) Long-term outcomes of shelf acetabuloplasty for developmental dysplasia of the hip in adults: a minimum 20-year follow-up study. J Orthop Sci 16(6):698–703. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Nishimatsu H, Iida H, Kawanabe K, Tamura J, Nakamura T (2002) The modified Spitzy shelf operation for patients with dysplasia of the hip. A 24-year follow-up study. J Bone Joint Surg Br 84(5): 647–652. Pubmed:
  15. 15.
    Holm AG, Reikeras O, Terjesen T (2017) Long-term results of a modified Spitzy shelf operation for residual hip dysplasia and subluxation. A fifty year follow-up study of fifty six children and young adults. Int Orthop 41(2):415–421. CrossRefPubMedGoogle Scholar
  16. 16.
    Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Acta Chir Scand Suppl 58(suppl):7–38Google Scholar
  17. 17.
    Takeda H, Kamogawa J, Sakayama K, Kamada K, Tanaka S, Yamamoto H (2006) Evaluation of clinical prognosis and activities of daily living using functional independence measure in patients with hip fractures. J Orthop Sci 11:584–591. CrossRefPubMedGoogle Scholar
  18. 18.
    Sharp IK (1961) Acetabular dysplasia. The acetabular angle. J Bone Joint Surg Br 43-B:268–272CrossRefGoogle Scholar
  19. 19.
    Heyman CH (1950) Legg-Perthes disease; a method for the measurement of the roentgenographic result. J Bone Joint Surg Am 32(4):767–778CrossRefPubMedGoogle Scholar
  20. 20.
    Tönnis D, Brunken D (1968) Differentiation of normal and pathological acetabular roof angle in the diagnosis of hip dysplasia. Evaluation of 2294 acetabular roof angles of hip joints in children. Arch Orthop Unfallchir 64:197–228. Pubmed:
  21. 21.
    Summers BN, Turner A, Wynn-Jones CH (1988) The shelf operation in the management of late presentation of congenital hip dysplasia. J Bone Joint Surg Br 70-B(1): 63–68. Pubmed:
  22. 22.
    Ipplito E, Ishii Y, Ponseti IV (1980) Histologic, histochemical, and ultrastructural studies of the hip joint capsule and ligamentum teres in congenital dislocation of the hip. Clin Orthop Relat Res 146:246–258. Pubmed:
  23. 23.
    Okano K, Enomoto H, Osaki M, Shindo H (2008) Rotational acetabular osteotomy for advanced osteoarthritis secondary to developmental dysplasia of the hip. J Bone Joint Surg Br 90(1):23–26. CrossRefPubMedGoogle Scholar
  24. 24.
    Okano KEH, Osaki M, Shindo H (2004) Clinical results of rotational acetabular osteotomy (RAO) for osteoarthritis of the hip (Ninomiya type 3): evaluation of the shape of the femoral head. Hip Joint 30:39–44 (in Japanese) Google Scholar
  25. 25.
    Fawzy E, Mandellos G, De Steiger R, McLardy-Smith P, Benson MK, Murray D (2005) Is there a place for shelf acetabuloplasty in the management of adult acetabular dysplasia? A survivorship study. J Bone Joint Surg Br 87(9):1197–1202. CrossRefPubMedGoogle Scholar
  26. 26.
    Mori R, Yasunaga Y, Yamasaki T, Hamanishi M, Shoji T, Ochi M (2013) Ten year results of transtrochanteric valgus osteotomy with or without the shelf procedure. Int Orthop 37(4):599–604. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tamaki T, Oinuma K, Miura Y, Shiratsuchi H (2016) Total hip arthroplasty after previous acetabular osteotomy: comparison of three types of acetabular osteotomy. J Arthroplasty 31(1):172–175. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Sendai Redcross HospitalSendaiJapan
  3. 3.Tohoku Hip Joint CenterSendaiJapan

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