Osteotomy for osteoarthritis of the hip. A survivorship analysis

Isolated varus intertrochanteric osteotomy for hip dysplasia in 52 patients: long-term results

Great strides have been made in the field of total hip arthroplasty, but the issue of wear and osteolysis continue to be a problem, mostly for young adults. For this population varus rotational osteotomy still remains a viable alternative to total hip arthroplasty. The purpose of this prospective study was to describe the indications, the technique and the functional outcome of an isolated varus femoral osteotomy in 52 patients with hip dysplasia. We obtained very good results with a significant improvement of hip function and pain relief. We conclude that with appropriate selection of the patient the procedure may prevent or postpone the development of secondary osteoarthritis.

Follow-up of intertrochanteric osteotomy of the hip during a 25-year period

In 1984, in reporting follow-up on 67 hips in 61 patients who underwent intertrochanteric osteotomies for osteoarthritis of the hip, we found that between 12 and 15 years after osteotomy, 34% (23) of the 67 hips remained functional and the remainder had been converted to an arthroplasty. We now report on the fate of those osteotomies over a 25-year period. Ten patients with 10 osteotomies did not require an arthroplasty, having died without requiring conversion to total hip arthroplasty at an average of 18.3 years after osteotomy (range: 11 to 24.1 years). Two others were living at an average of 25.2 years after osteotomy without requiring conversion. Thus, for 18% of the hips, no further hip surgery was performed. For the remaining 55 hips in 49 patients, the osteotomy had served for an average of 9.8 years (range: 1.3 to 26.1 years) before requiring arthroplasty. The cumulative probability of osteotomy survival was 57.8% (standard error: 6.0%) at 10 years, 20.0% (standard error: 4.9%) at 20 years, and 5.7% (standard error: 2.9%) at 25 years by Kaplan-Meier survivorship analysis.

Cemented total hip arthroplasty following previous femoral osteotomy: an average 16-year follow-up study

The indications for proximal femoral osteotomy would be substantially limited if it significantly compromised the outcome of a subsequent hip arthroplasty. Previous reports have followed only early cementing techniques over intermediate duration. This study comprised 22 primary cemented total hip arthroplasties performed by a single surgeon following failed proximal femoral osteotomies at an average follow-up period of 15.8 years. Three patients who died prior to the 11-year minimum follow-up period are not included, leaving 19 hips for long-term review. All stems were cemented with second-generation techniques. Stem placement and collar-calcar contact, however, were substantially worse compared with historical control subjects. Eight reconstructions required custom miniature or calcar replacement components, and in 6 hips, the stems were inserted only in the diaphysis. Two of 19 femoral components (10.5%) were revised for aseptic loosening and 2 additional femoral components were loose. The average Harris hip score of those not revised was 80.4. Five acetabular components (26.3%) required revision. Four additional cups were loose, yielding a total acetabular loosening rate of 47.4% at 15.5 years. Intertrochanteric osteotomy in general did not affect the expected excellent results of the femoral component using modern cementing techniques. Severe deformity following subtrochanteric osteotomy, however, did adversely affect the outcome.