Rotational acetabular osteotomy with excision of the capital drop for advanced osteoarthritis secondary to developmental dysplasia of the hip.
ABSTRACT Advanced-stage osteoarthritis may occasionally be associated with capital drop of the femoral head. In such cases, excision of the capital drop is performed to obtain good congruency with sufficient coverage of the femoral head by rotational acetabular osteotomy (RAO). In the present study, we examined the outcome of RAO with excision of the capital drop.
Rotational acetabular osteotomy (RAO) with excision of the capital drop was performed in 17 hips of 16 patients with a mean follow-up of 12.6 years (excision group), while only RAO was performed in 42 hips of 41 patients with a mean follow-up of 12.3 years (non-excision group). All 57 patients indicated radiographic evidence of advanced-stage osteoarthritis. Clinical follow-up was performed using the Merle d'Aubigné and Postel system. The clinical and radiological results were compared between the two groups.
The mean Merle d'Aubigne and Postel's total hip-joint scores at follow up significantly (p < 0.001) improved compared with the mean pre-operative scores only in the non-excision group. While the numbers of hips in excision group (17 hips) showing progressive and non-progressive osteoarthritic changes were 10 and 7, those in the non-excision group (42 hips) were 11 and 20, respectively. Although none (0/17) in the excision group showed any improvement in osteoarthritic stage at follow up, 11 of 42 hips indicated a favorable outcome in the non-excision group. There were significantly (p = 0.0077) higher improvements in osteoarthritis stage in the non-excision than excision group. Three patients each of the excision group (18%) and non-excision group (7%) underwent total hip arthroplasty during the follow-up period.
Excision of capital drop of the femoral head is not a useful adjunct to the RAO procedure for the treatment of advanced osteoarthritis. Based on results from a previous study, Chiari pelvic osteotomy may serve as a more favorable alternative.
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ABSTRACT: Rotational acetabular osteotomy (RAO) is an established joint preservation technique for early stage osteoarthritis (OA). To extend the application of RAO for advanced OA with significant osteophyte formation, we added intraarticular procedures including removal of the double floor and the capital drop to create medialisation and better coverage of the femoral head. The procedures were performed for seven joints with advanced OA. The average age of patients at surgery was 39 years. The follow-up periods ranged from five to 23 years. The capital drop was resected in five joints and both the capital drop and the double floor were removed in the other two joints. The Japanese Orthopaedic Association Hip Score improved from 53 points before surgery to 69 at the latest follow-up. The range of flexion was decreased. The centre-edge angle, Sharp angle and acetabular head index were significantly improved. The femoral head was medialised 5 mm by surgery. Three joints (43%) showed progression of osteoarthritis. One joint (14%) needed replacement at seven years after RAO. Resection of the capital drop and curtain osteophyte with RAO improved joint congruity and medialisation of the femoral head, but decreased the range of motion of the joint due to increased bony coverage. Progression of degeneration of the joint is not preventable. We abandoned these procedures for advanced osteoarthritis of the hip joint especially in older patients who were suitable for replacement arthroplasty.Hip international: the journal of clinical and experimental research on hip pathology and therapy 01/2013; 23(2). DOI:10.5301/hipint.5000008 · 0.76 Impact Factor