HSS Journal

, Volume 5, Issue 2, pp 137–142 | Cite as

Rotational Acetabular Osteotomy for Secondary Osteoarthritis After Surgery for Developmental Dysplasia of the Hip

  • Masahiko Nozawa
  • Katsuhiko Maezawa
  • Keiji Matsuda
  • Sungon Kim
  • Katsuo Shitoto
  • Hisashi Kurosawa
 

Abstract

The treatment of residual deformity following surgery for developmental dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. This can improve joint function as well as achieve relief of pain. However, it is unclear if this osteotomy can improve a compromised hip when performed for the treatment of residual deformity and acetabular dysplasia after surgery for developmental dysplasia of the hip. We aimed to report the clinical outcome as assessed by need for total hip arthroplasty (THA) and by the Merle d’Aubigné and Postel scores. In addition, we tried to assess the radiographic outcomes as assessed by Tönnis’s classification. Only two hips required THA, which was performed in two patients at 11 and 12 years after RAO, respectively. The mean Merle d’Aubigné clinical score improved from 14.1 ± 2.3 points (range, 10 to 17) preoperatively to 15.8 ± 2.9 points (8 to 18) at final follow-up (p < 0.02). Radiological assessment at final follow-up showed the obvious progression of osteoarthritis in five hips. One patient in grade 1 preoperatively progressed into grade 3 at final follow-up; four patients in grade 2 preoperatively progressed into grade 3. In our study, this osteotomy prolonged the functional life of the hip, and only two hips needed THA after a mean follow-up of 11 years. We found that advanced arthritis pre-osteotomy is associated with progression of radiologic changes

Keywords

rotational acetabular osteotomy residual deformity after surgery for developmental dysplasia of the hip 

References

  1. 1.
    Ottolenghi CE, Frigerio E (1962) Intertrochanteric osteotomies in osteo-arthritis of the hip: fundamentals, indications, techniques, and results. J Bone Joint Surg [Am] 44-A:855–1030Google Scholar
  2. 2.
    Callaghan JJ, Brand RA, Pedersen DR (1985) Hip artrodesis. A long-term follow-up. J Bone Joint Surg [Am] 67-A:1328–1335Google Scholar
  3. 3.
    Sutherland DH, Greenfield R (1977) Double innominate osteotomy. J Bone Joint Surg [Am] 59-A:1082–1091Google Scholar
  4. 4.
    Nozawa M, Shitoto K, Matsuda K, Maezawa K, Kurosawa H (2002) Rotational acetabular osteotomy for acetabular dysplasia. J Bone Joint Surg [Br] 84-B:59–65CrossRefGoogle Scholar
  5. 5.
    Merle d’Aubigné R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg [Am] 36-A:451–475Google Scholar
  6. 6.
    Ninomiya S, Tagawa H (1984) Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg [Am] 66-A:430–4361Google Scholar
  7. 7.
    Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer, New York, pp 165–171Google Scholar
  8. 8.
    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 83:1–135Google Scholar
  9. 9.
    Heyman CH, Herndon CH (1950) Legg–Perthes disease: a method for the measurement of the roentgenographic result. J Bone Joint Surg [Am] 32-A:767–778Google Scholar
  10. 10.
    Nozawa M, Shitoto K, Matsuda K, Maezawa K, Ogawa S, Yuasa T, Aritomi K, Kurosawa H (2006) Original methods to move femoral head medially and caudally after rotational acetabular osteotomy: especially to use ceramic spacer. Arch Orthop Trauma Surg 126:421–424PubMedCrossRefGoogle Scholar
  11. 11.
    Hellemondt GG, Sonneveld H, Schreuder MHE, Kooijman MAP, De Kleuver M (2005) Triple osteotomy of the pelvis for acetabular dysplasia. J Bone Joint Surg [Br] 87-B:911–915Google Scholar
  12. 12.
    Garras DN, Crowder TT, Olson SA (2007) Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg [Br] 89-B:721–724Google Scholar
  13. 13.
    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-B:23–26Google Scholar

Copyright information

© Hospital for Special Surgery 2009

Authors and Affiliations

  • Masahiko Nozawa
    • 1
  • Katsuhiko Maezawa
    • 2
  • Keiji Matsuda
    • 1
  • Sungon Kim
    • 1
  • Katsuo Shitoto
    • 3
  • Hisashi Kurosawa
    • 2
  1. 1.Department of Orthopaedic SurgeryJuntendo University Nerima HospitalNerima-kuJapan
  2. 2.Department of Orthopaedic SurgeryJuntendo University HospitalBunkyo-kuJapan
  3. 3.Department of Orthopaedic SurgeryJuntendo University Urayasu HospitalUrayasu CityJapan

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