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Rotational Acetabular Osteotomy for Advanced Osteoarthritis Secondary to Dysplasia of the Hip
Yuji Yasunaga, MD, PhD1; Mitsuo Ochi, MD, PhD1; Hiroshi Terayama, MD1; Ryuji Tanaka, MD, PhD1; Takuma Yamasaki, MD, PhD1; Yoshimasa Ishii, MD1
1 Department of Artificial Joints and Biomaterials (Y.Y. and Y.I.) and Department of Orthopaedic Surgery (M.O., H.T., R.T., and T.Y.), Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima City 734-8551, Japan. E-mail address for Y. Yasunaga: yasuyuji@hiroshima-u.ac.jp
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Artificial Joints and Biomaterials and the Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Sep 01;88(9):1915-1919. doi: 10.2106/JBJS.E.00715
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Abstract

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.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Chen-Kun Liaw
    Posted on January 22, 2007
    The Importance of Knowing Anteversion Values Before and After Rotational Acetabular Osteotomy
    En Chu Kong Hospital & Ph.D. candidate of Nat'l Taiwan U. Comp. Sci. & Info. Engineering Dept.

    To The Editor:

    In the paper "Hip Rotational Acetabular Osteotomy for Advanced Osteoarthritis Secondary to Dysplasia of the Hip" (1), Yasunaga et al. presented their experience on acetabular osteotomy to treat advanced osteoarthritis secondary to hip dysplasia in the young adults. The authors measured many radiological parameters, including the center-edge angle, the mean acetabular roof angle, the mean head lateralization index, and the mean minimum width of the joint space.

    However, they did not report the anteversion values of these acetabulae pre or post operatively. The report of Parvizi et al.(2) states that range of motion of the hip is influenced by the anteversion of acetabulum and it will be expected to change after pelvic osteotomy. In addition, suitable correction is important because retroversion of the hip (positive cross- over sign) may predispose to osteoarthritis.(3,4,5)

    Since this article(1) did not provide the radiographs for study, we reviewed the radiographs of patients presented in the article by Ninomiya and Tagawa(6) that discussed the same osteotomy technique. We determined the presence or absence of the cross-over sign before and after operation, and we measured the radiographic anteversion of the hips using our previous published method(7). Fig.1A(below) shows that there is negative cross-over sign (anteverted hips) preoperatively, and figure 1B shows a positive cross-over sign (neutral or retroverted hips) postoperatively in one of the patients presented in that article(6). Fig.2(below) uses our method(7) to measure the radiographic anteversion of the acetabulum in one of the hips from the same patient (6). In this example, the anteversion is 17 degrees.

    In Table 1 (below) we show the presence or absence of the cross-over sign and magnitude of radiographic anteversion that we measured on the 4 patients (5 hips) presented in the paper by Ninomiya and Tagawa(6). The cross-over sign was negative in four of five hips before operation, while after operation the cross-over sign was positive in all hips which indicates reduced anteversion or retroversion. The mean radiographic anteversion of the acetabulum before osteotomy was 17.4 degrees (range: 10 to 25 degrees. In contrast,the post osteotomy mean anteversion was 2 degrees(range: -10 to 5 degrees)(paired t-test, p=0.001). Since correction into anteversion may play an important role in preventing osteoarthritis progression, we would be grateful to know the pre and post operative anteversion values of the patients reported in the present study (1).


    Fig. 1-A


    Fig. 1-B


    Fig. 2

    Table 1

     
    Fig. 9
    Fig. 10
    Fig. 11
    Fig. 12
    right
    left
    left
    right
    left
    Pre
    Post
    Pre
    Post
    Pre
    Post
    Pre
    Post
    Pre
    Post
    Cross-over sign
    −
    +
    −
    +
    −
    +
    −
    +
    +
    +
    Radiographic Anteversion
    17
    5
    25
    5
    20
    −5
    15
    −5
    10
    −10

    The authors of this did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

    References:

    1. Yuji Yasunaga, Mitsuo Ochi, Hiroshi Terayama, Ryuji Tanaka, Takuma Yamasaki and Yoshimasa Ishii. Hip rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip. J Bone Joint Surg Am. 2006;88:1915-1919.

    2. Parvizi J., Campfield A., Clohisy J. C., Rothman R. H., Mont, MA. Management of arthritis of the hip in the young adult. J Bone Joint Surg Br. 2006 88-B: 1279-1285

    3. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop. 2003;417:112-20.

    4. Parvizi J, Ganz R. Femoroacetabular impingement. Sem Arthroplasty. 2005;16:33-37.

    5. Siebenrock KA, Schoengiger R, Ganz R. Anterior femoroacetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85-A:278-86.

    6. S Ninomiya, H Tagawa. Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am. 1984;66:430-436.

    7. Liaw CK, Hou SM, Yang RS, et al. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clin Orthop. 2006;451:134-139.

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