[The Osaka concept. "Dome osteotomy" with of without labrum resection].
Departement of Orthopedic Surgery, Osaka University Medical School, Japan. Der Orthopäde
(Impact Factor: 0.36).
Acetabular dysplasia represents the most common aetiology for secondary osteoarthritis of the hip joint in Japan. On radiographs progress of the disease can be classified in four stages (I to IV). Labral lesions are common accompanying findings in acetabular dysplasia, representing an important prognostic factor. Therefore we routinely use conventional arthrography to classify labral lesions in three types (normal, torn and detached). From 1978 to 1983 a modified Chiari osteotomy of the pelvis (dome osteotomy) was performed in 64 hip joints without arthrotomy. The preoperative radiography showed labral lesions in 66%. After an average follow-up of 4 years, 43 of the 44 patients with a normal or torn labrum showed excellent or good results. On contrast, 50% of the 20 patients with a detached labrum showed fair and poor results only. From 1984 to 1989 an arthrotomy was combined with dome osteotomy in 29 hip joints and labral lesions had to be resected in 16 cases. The results were generally good in patients with arthrosis grade I and II, but in stage III they were only fair. Thus, the success of labral surgery can only be achieved in early stages of dysplasia. Based on our findings dome osteotomy combined with arthrotomy and labral surgery can be recommended in patients with labral lesions and hip dysplasia grade I and II.
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ABSTRACT: Developmental hip dysplasia in adults causes several anatomical changes which can lead to premature and progressive secondary osteoarthritis. The principle of Chiari osteotomy is the medialisation of the subluxated femoral head. This improves the biomechanics of the hip. The goal of the study was to assess the long term results of Chiari innominate osteotomy.
The authors evaluated 130 hips after Chiari ostetomy from 230 patients operated on in the sears 1969-1985 at the Ist Orthopaedic Department of St. Anna University Hospital in Brno, Czech Republic. The mean follow-up was 22.3 years (15-30) and there were 125 women and 5 men. The average age at the time of the procedure was 29 years (15-52).
We assessed the Harris hip score, daily activities, the length of the improvement after the procedure and asked the patients if they would undergo again the same procedure. We also assessed the CE angle, the Sharp angle, AHI index, the CCD angle, the Shenton's line, Crowe type of dysplasia, the shape of the femoral head and Kellgren-Lawrence grades of the osteoarthritis. There were 5 types of hip dysplasia in the study: coxa valga subluxans, coxa valga luxans, coxa plana brevis, coxa magna and severe deformity of the femoral head. There were 26 cases of hip dysplasia alone, 87 cases of hip dysplasia with a subluxation of the femoral head and 13 cases of dysplasia with a false acetabulum. We searched for the factors influencing the end results. We measured the medial shift of the distal pelvic fragment and the level of the osteotomy.
The mean nmedial shift of the distal fragment was 22 mm e.g. 48.6%. There was a correct level of the osteotomy in 113 patients. Radiological features improved: the CE angle (-12 degrees to +37.2 degrees), the Sharp angle (48 degrees to 41 degrees), AHI index (51 to 96.3%). The Harris hip score improved from 42 points to 67.5 points an average. 65 patients have been satisfied with the procedure, 49 were partialy satisfied and 16 were not satisfied. There were 80 patients without any other procedure (the first group) and there were 50 patients with the conversion to total hip replacement at the time of the latest follow-up (the second group). The mean age at the time of the operation was 24.2 years in the first group and 33.7 years in the second group. 62 patients in the first group had no osteoarthritis or grade 1 osteoarthritis at the time of the operation. 43 patients in the second group had grade 2 or 3 osteoarthritis at the time of the operation. The favourable results of the operation lasted 17.6 years in the first group and 11.1 years in the second group. The time between Chiari osteotomy and the conversion to total hip replacement was 12.2 years in the second group.
The favourable factors are the age up to 30 years, no osteoarthritis or the grade 1 of osteoarthritis, coxa valga subluxans of Crowe type I and type II of hip dysplasia with a normal Shenton line, the spherical and ovoid shape of the femoral head, the correct level of the osteotomy and full coverage of the femoral head (medial shift 40%). The unfavourable factors for long term results were older age (over 35 years) of the patient at the time of the operation, grade 2 and 3 of osteoarthritis, severe deformity of the femoral head, Crowe type III of hip dysplasia with broken Shenton's line more than 20 mm, an angular shape of the femoral head, a CE angle bellow -15 degrees, a high CCD angle (near to 180 degrees) and incorrect procedure technique.
The study approved a favourable effect of Chiari pelvic osteotomy in patients with residual developmental hip dysplasia. The authors evaluated 130 patients operated on in the years 1969-1985 with a mean follow-up 22.3 years. In the first group (80 patients) a favourable result lasted an average of 17.6 years (3-30). 37 patients are still painfree, 35 patients have conservative treatment for osteoarthritis, 8 patients are planning a conversion to total hip replacement. Radiological signs have improved substantialy. Harris hip score has improved from 42 points to 67.5 points on average. In the second group (50 patients) a favourable result lasted for average 11.1 years (0-29). All of them had a conversion to total hip replacement at the average of 12.2 years. Chiari osteotomy gives the patients with residual developmental hip dysplasia and a correct indication favourable long-term results. It diminishes pain, prevents further subluxation and reduces the development of secondary osteoarthritis of the hip joint. (Tab. 6, Ref. 23.).
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ABSTRACT: The presence of a damaged labrum is one of many factors influencing the outcomes of Chiari pelvic osteotomy. However, there are few previous papers describing the long-term outcomes of Chiari pelvic osteotomy with labrectomy. The purpose of this study was to evaluate the long-term clinical and radiological outcomes of Chiari pelvic osteotomy for dysplastic hips with labral tears. We compared outcomes between labrectomy (+) and labrectomy (-) groups.
Chiari pelvic osteotomies were performed by one surgeon on 34 dysplastic hips with labral tears between 1983 and 1996, in which labrectomy was performed on 23 hips but not on 11 hips. Three patients undergoing labrectomy were lost to follow-up evaluation within 5 years after surgery. The average age of the remaining 31 patients was 35.5 years (range, 16-54 years). The clinical and radiographic surveillance averaged 16.0 years (range, 10-23.3 years).
In all patients, pain disappeared after the operation. At the end of the study, 8 of the 31 patients displayed clinical deterioration. Progression of osteoarthritis (OA) was observed in 11 hips. Patients with poor results have not opted for revision surgery except for one patient. In the labrectomy (+) group, 10 of the 20 hips showed progression of OA and the clinical outcomes of 6 patients deteriorated. In the labrectomy (-) group, 1 of the 11 hips showed progression of OA and 2 patients deteriorated clinically. Radiological outcomes differed significantly between the two groups.
Labrectomy accompanying Chiari pelvic osteotomy is an acceptable procedure for relieving pain caused by the damaged labrum, but the outcomes have a tendency to deteriorate after 10 or more years postoperatively.
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