Background: Satisfactory intermediate and long-term results of
rotational acetabular osteotomy for the treatment of early osteoarthritis
secondary to developmental dysplasia of the hip have been reported. The
purpose of this study was to examine the results of rotational acetabular
osteotomy in patients with advanced osteoarthritis secondary to developmental
dysplasia of the hip.
Methods: We performed a retrospective review of the results of
rotational acetabular osteotomy in forty-three patients (forty-three hips).
All of the patients had radiographic evidence of advanced-stage
osteoarthritis, defined as narrowing of the joint space with cystic
radiolucencies and small osteophytes according to the staging system of the
Japanese Orthopaedic Association. Forty-one patients were female, and two were
male. The mean age was 43.8 years at the time of surgery, and the mean
duration of follow-up was 8.5 years. Clinical follow-up was performed with use
of the system of Merle d'Aubigné and Postel. The center-edge angle,
acetabular roof angle, head lateralization index, and minimum width of the
joint space were measured on radiographs made preoperatively, postoperatively,
and at the time of final follow-up. Postoperative joint congruency was
classified into four grades.
Results: The mean preoperative Merle d'Aubigné clinical score
was 13.3 points, which improved to a mean of 15.4 points at the time of the
latest follow-up (p < 0.0001). The mean center-edge angle improved from
0.7° preoperatively to 29° at three months postoperatively (p <
0.0001), the mean acetabular roof angle improved from 30° to 11° (p
< 0.0001), the mean head lateralization index improved from 0.69 to 0.65 (p
< 0.01), and the mean minimum width of the joint space improved from 2.2 to
2.5 mm (p < 0.0003). Ten hips had radiographic evidence of progression of
osteoarthritis. Kaplan-Meier survivorship analysis, with radiographic signs of
progression of osteoarthritis as the end point, predicted a ten-year survival
rate of 72.2%.
Conclusions: Rotational acetabular osteotomy for advanced
osteoarthritis secondary to dysplasia of the hip in properly selected patients
can improve clinical scores and is associated with a lack of radiographic
signs of progression of osteoarthritis in most patients.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.