0
Scientific Articles   |    
Outcome at Forty-five Years After Open Reduction and Innominate Osteotomy for Late-Presenting Developmental Dislocation of the Hip
Simon R. Thomas, MA, FRCS(Tr&Orth)1; John H. Wedge, MD, FRCS(C)2; Robert B. Salter, MD, FRCS(C)2
1 3 Oakthorpe Road, Oxford OX2 7BD, United Kingdom. E-mail address: simonthomas@doctors.org.uk
2 The Hospital for Sick Children, 555 University Avenue, Toronto, ON M59 1X8, Canada
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Physicians Services Incorporated and the Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada. 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.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Investigation performed at The Hospital for Sick Children, Toronto, Ontario, Canada

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Nov 01;89(11):2341-2350. doi: 10.2106/JBJS.F.00857
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: A consecutive series of seventy-six patients (101 hips) underwent primary open reduction, capsulorrhaphy, and innominate osteotomy for late-presenting developmental dislocation of the hip. They were between 1.5 and five years old at the time of surgery, which was done between 1958 and 1965. The present study was designed to review the outcome of these patients into middle age.

Methods: We located and reviewed the cases of sixty patients (eighty hips), which represents a 79% rate of follow-up at forty to forty-eight years postoperatively. Nineteen patients (twenty-four hips) had undergone total hip replacement, and three (three hips) had died of unrelated causes. The remaining thirty-eight patients (fifty-three hips) were assessed by the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and Oxford hip score questionnaires, physical examination, and a standing anteroposterior pelvic radiograph. The radiographs were analyzed to determine the minimum joint space width and the Kellgren and Lawrence score. Accepted indices of hip dysplasia were measured.

Results: With use of Kaplan-Meier survival analysis and with the end point defined as total hip replacement, the survival rates at thirty, forty, and forty-five years after the reduction were 99% (95% confidence interval, ±2.4%), 86% (95% confidence interval, ±6.9%), and 54% (95% confidence interval, ±16.4%), respectively. The average Oxford hip score and WOMAC score for the surviving hips were 16.8 (range, 0 to 82) and 16.7 (range, 0 to 71), respectively. Of the fifty-one hips for which radiographs were available, thirty-eight demonstrated a minimum joint space width of >2.0 mm and thirteen demonstrated definite osteoarthritis on the basis of this criterion. Osteoarthritis, according to the system of Kellgren and Lawrence, was grade 0 or 1 in twenty-nine hips, grade 2 in seven hips, and grade 3 or 4 in fifteen hips. The average center-edge and acetabular angles were 40° (range, 0° to 61°) and 32° (range, 20° to 43°), respectively. With the numbers studied, no significant association was detected between outcome and the modifiable risk factors of body mass index or age at the time of surgery. Hips in patients with bilateral involvement were at significantly greater risk of failure (p = 0.02).

Conclusions: This method of treatment achieves a 54% rate of survival of the hip at forty-five years. Two-thirds of the surviving hips have an excellent prognosis forty to forty-eight years after the index procedure according to the Kellgren and Lawrence score.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Sharaf B Ibrahim, FRCS, MS Orth
    Posted on September 09, 2008
    The Salter Osteotomy
    Hospital Univ Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

    EDITOR'S NOTE: The authors were invited to respond to this letter, but to date, have not done so.

    To the Editor:

    I read with interest and congratulate the authors on publishing results of the Salter innominate osteotomy at a forty-five year follow-up (1).

    The result shows a 54% rate of survival of the hip at 45 years. Conversely, this means that 46% of the hips failed over time. Couldn't the results be interpreted to also mean that although the Salter osteotomy improves anterolateral coverage of the femoral head, it results in concomitant deficient coverage posteriorly?

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family 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 author, or a member of his immediate family, is affiliated or associated.

    References:

    1. Simon R. Thomas, John H. Wedge, and Robert B. Salter Outcome at Forty-five Years After Open Reduction and Innominate Osteotomy for Late-Presenting Developmental Dislocation of the Hip J Bone Joint Surg Am 2007; 89: 2341-2350

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    04/02/2014
    W. Virginia - Charleston Area Medical Center
    02/28/2014
    District of Columbia (DC) - Children's National Medical Center