RT Journal
A1 Ito, Hiroshi
A1 Matsuno, Takeo
A1 Minami, Akio
T1 Chiari Pelvic Osteotomy for Advanced Osteoarthritis in Patients with Hip Dysplasia
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2004
FD July 1
VO 86
IS 7
SP 1439
OP 1445
DO 
UL http://dx.doi.org/
AB Background: It is not clear whether a Chiari pelvic osteotomy
performed for the treatment of advanced osteoarthritis can delay the need for
total hip arthroplasty. We present the mid-term results of the Chiari pelvic
osteotomy performed for the treatment of Tönnis grade-3 osteoarthritis
(large cysts, severe narrowing of the joint space, or severe deformity or
necrosis of the head with extensive osteophyte formation), with a particular
focus on whether this procedure can delay the need for total hip
arthroplasty.Methods: We followed thirty-two hips in thirty-one patients with
Tönnis grade-3 osteoarthritis who had refused total hip arthroplasty and
had been treated with a Chiari pelvic osteotomy. The mean age at the time of
surgery was 35.2 years. The mean duration of follow-up was 11.2 years, at
which time clinical evaluation with the Harris hip score and radiographic
evaluation were performed.Results: The average Harris hip score improved from 52 points
preoperatively to 77 points at the time of follow-up; the average pain score
improved from 20 to 31 points. Three hips with a hip score of <70 points
required total hip arthroplasty. With a hip score of <70 points as the end
point, the cumulative rate of survival at ten years was 72%. The clinical
outcome was significantly influenced by the preoperative center-edge angle (p
= 0.004), the preoperative acetabular head index (p = 0.039), achievement of
the appropriate osteotomy level (p = 0.011), and superior migration (p =
0.009) and lateral migration (p = 0.026) of the femoral head.Conclusions: Although the clinical results were inferior to those of
total hip arthroplasty, Chiari pelvic osteotomy may be an option for young
patients with advanced osteoarthritis who prefer a joint-conserving procedure
to total hip arthroplasty and accept a clinical outcome that is predicted to
be less optimal than that of total hip arthroplasty. Moderate dysplasia and
moderate subluxation without complete obliteration of the joint space and a
preoperative center-edge angle of at least —10° are desirable
selection criteria.Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.