Long-term results of valgus-extension femoral osteotomy for advanced osteoarthritis of the hip

Long-term results of valgus osteotomy for terminal-stage osteoarthritis of the hip

INTRODUCTION

Pauwels' femoral osteotomy is a classical and joint-preserving method for osteoarthritis of the hip caused by acetabular dysplasia and/or subluxation. However, its application for terminal-stage osteoarthritis of the hip, and the long-term results, have not yet been reported. We herein aim to investigate the long-term results of valgus osteotomy for terminal-stage osteoarthritis of the hip.

METHODS

Eighty-two hips of 75 patients (74 women and 1 man, mean age: 48.1 years) classified as having terminal-stage osteoarthritis by Kellgren and Laurence were indicated for valgus osteotomy from 1984 to 1993. Sixty-three hips of 57 patients were followed for more than 20 years (mean: 298 months). Follow-up rate was 77%.

RESULTS

Preoperative mean hip score (Harris Hip Score) was 46.4 points. Thirty-two hips were later converted to total hip arthroplasty (THA) (mean: 185 months after surgery). Of the hips without conversion to THA, 31 hips scored 72.8 points on average, and 21 hips scored 70 or more points at the final follow-up. Kaplan-Meier survivorship analysis revealed that 40% of the hips, classified as non-atrophic type (according to Bombelli's classification) at the time of operation, maintained their joint space width for 20 years (endpoint: less than 1 mm at the weight-bearing segment, i.e., recurrence of osteoarthritis) and also revealed that 60% of the hips were not converted for 20 years after the initial operation (endpoint: conversion to THA). Cox's proportional hazard model revealed that those with the atrophic type had a hazard risk 24 times greater than those with the non-atrophic type of osteoarthritis.

CONCLUSION

This is the first report of the long-term results of osteotomy for terminal-stage osteoarthritis of the hip showing satisfactory results with a lengthy follow-up period. Pauwels' valgus femoral osteotomy for terminal-stage osteoarthritis, excluding atrophic type, could be an acceptable alternative to THA.

Ten year results of transtrochanteric valgus osteotomy with or without the shelf procedure

PURPOSE

The purpose of this study was to examine retrospectively the effectiveness of Sugioka's transtrochanteric valgus osteotomy (TVO) combined with the shelf procedure for patients who had advanced osteoarthritis (OA) of the hip with severe acetabular dysplasia.

METHODS

Sixty-two hips in 61 patients were reviewed retrospectively between April 1993 and March 2009. Of these hips, 25 hips with the pre-operative acetabular head index (AHI) ≥ 60 % (single group) underwent a TVO, whereas the other 37 with AHI < 60 % (combined group) underwent a TVO combined with the shelf procedure.

RESULTS

Using conversion to total hip arthroplasty as the endpoint, the Kaplan-Meier survival rates at ten years were calculated to be 85.5 % for the single group and 100 % for the combined group; there was a significant difference between the two groups (p < 0.05, log-rank test). Similarly, calculated using progressive OA as the endpoint, survival rates at ten years were 69.5 % and 89.3 % respectively; there was also a significant difference between the two groups (p < 0.05, log-rank test). In the single group, the latest radiographic evaluations of the patients with the pre-operative AHI ≥ 70 % were significantly better than those of the patients with the pre-operative AHI < 70 % (P < 0.05).

CONCLUSION

More satisfactory ten year results of TVO were obtained in cases that had a pre-operative AHI of ≥70 %, or where the shelf procedure was added. It is desirable that acetabuloplasty be added for patients with pre-operative AHI < 70 %.

Reliability and validity of the Japanese Orthopaedic Association hip score

BACKGROUND

The Japanese Orthopaedic Association (JOA) hip score has been widely used in Japan as a method to assess hip joint diseases. The JOA hip score consists of four subcategories: pain (Pain), range of motion (ROM), ability to walk (Gait), and activities of daily life (ADL). We present the first report to verify the reliability and validity of the JOA hip score.

METHODS

A total of 123 patients with osteoarthritis of a unilateral hip and 29 patients with osteonecrosis of a unilateral hip were investigated. The JOA hip score was recorded by orthopedic surgeons in their offices. On the same day, each patient answered a Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (Japanese version 1.2) by himself or herself. The SF-36 survey measures eight subscales. The internal-consistency reliability of the JOA hip score was evaluated by Cronbach's coefficient alpha. The validity of the JOA hip score was tested by Spearman's correlation coefficients between the four subcategories of the JOA hip score and the eight SF-36 subscales.

RESULTS

When patients with osteoarthritis with conservative treatment were assessed by the JOA hip score, Cronbach's coefficient alpha was 0.70, demonstrating internal-consistency reliability. However, when the JOA hip score was used for other groups, Cronbach's coefficient alpha was <0.70, demonstrating the lack of internal-consistency reliability. Significant correlations were observed between Pain and bodily pain (r = 0.63), between Gait and physical functioning (PF) (r = 0.70), and between ADL and PF (r = 0.81), but not in any other combinations.

CONCLUSIONS

We found that the JOA hip score is a reliable system only for patients with osteoarthritis of the hip with conservative treatment. The JOA hip score is a scaling system with convergent and discriminant validity for the assessment of physical function and pain.

Results and prognostic factors of valgus osteotomy in middle-aged patients with advanced or terminal osteoarthritis of the hip

BACKGROUND

From 1979 to 2005, a total of 279 hips in 249 patients with advanced and/or terminal-stage osteoarthritis of the hip underwent valgus osteotomy. Among them, we reviewed 256 hips in 229 patients (91.8%) with a minimum follow-up of 1 year. We reviewed the clinical and radiological results and analyzed prognostic factors that may have affected the postoperative outcome.

METHODS

Clinical evaluation was made according to the Japanese Orthopaedic Association Hip score (JOA score). Radiological evaluation was made according to the criteria of Itoman. The Kaplan-Meier method was used to calculate the probability of survival of valgus osteotomy from the time of the operation until the endpoint of a subsequent operation. To examine prognostic factors, clinical parameters and radiographic measurements were compared between patients in an improved group and an aggravated group. Additionally, clinical parameters and radiographic measurements were used to evaluate the JOA score at the latest follow-up.

RESULTS

The mean JOA score was 52.6 before the operation; it was 80.6, showing the most marked improvement, 5 years after the operation, gradually decreased thereafter; and it was 65.0 after 20 years. Radiological results were good or fair in 78% even 10 years after the operation. The survival rates were 91%, 63%, and 52%, respectively, at 10, 15, and 20 years after valgus osteotomy. Concerning prognostic factors, the improved group tended to show preoperative good range of motion and unilateral involvement. Concerning the association between prognostic factors and the JOA score at the latest follow-up observation, the JOA score was significantly lower for an acetabular head index (AHI) <60% than for AHI >or=60%.

CONCLUSIONS

Valgus osteotomy is effective joint-preserving surgery for advanced or terminal-stage osteoarthritis of the hip in middle-aged patients, and it is acceptable for clinical and radiological evaluation. If the AHI is <60%, valgus osteotomy should be combined with Chiari's pelvic osteotomy.

Good survival of uncemented tapered stems for failed intertrochanteric osteotomy: a mean 16 year follow-up study in 45 patients

INTRODUCTION

Inferior survival of cemented total hip arthroplasty has been reported after previous femoral osteotomy. We previously presented 5-15 years results of uncemented femoral stems for this subgroup of patients. The purpose of the present study was to re-evaluate that same patient group at 10-20 years follow-up.

MATERIALS AND METHODS

Forty-eight hips in 45 patients had undergone conversion THA for a failed intertrochanteric osteotomy of the hip after a mean of 12 years (2-33 years). Mean time of follow-up was 16 years (10-20 years).

RESULTS

At the latest follow-up five patients had died (five hips), and one patient (one hip) remained lost to follow-up. Compared to the previous evaluation, one more patient required femoral revision for aseptic loosening giving a total of four patients (four hips) with femoral revision--one for infection and three for aseptic loosening of the stem. Survival of the stem was 91% at 15 and 20 years respectively; survival with femoral revision for aseptic loosening as an end point was 93%. The median Harris-Hip-Score at final follow-up was 76 points (previously 80 points). Radiolucent lines in Gruen zones 1 and 7 were present in 20 and 17% of hips, respectively. Radiolucencies in other zones were not detected. There was no radiographic evidence of femoral osteolysis, stress-shielding or loosening.

CONCLUSION

The long-term results with this type of uncemented tapered titanium femoral component after proximal femoral osteotomy remain encouraging and compare favorably to those achieved in patients with regular femoral anatomy.

Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy

INTRODUCTION

Inferior survival of cemented total hip arthroplasty has been reported after previous femoral osteotomy. The purpose of this study was to evaluate the long-term survival of uncemented stems after femoral osteotomy.

MATERIALS AND METHODS

Forty-eight hips in 45 patients had undergone conversion THA for a failed intertrochanteric osteotomy of the hip after a mean of 12 years (2-33 years). Mean time of follow-up was 11 years (5-15 years).

RESULTS

At follow-up, two patients (three hips) had died, and one patient (one hip) was not located. Three patients (three hips) underwent femoral revision-one for infection and two for aseptic loosening of the stem. Survival of the stem was 94% at 10 years, and survival with femoral revision for aseptic loosening as an end point was 96%. The median Harris Hip Score at follow-up was 80 points. Radiolucent lines in Gruen zones 1 and 7 were present in 14 and 18% of hips, respectively. Radiolucencies in other zones were not detected. There was no radiographic evidence of femoral osteolysis, stress-shielding or loosening.

CONCLUSION

The results with this type of uncemented tapered titanium femoral component after proximal femoral osteotomy are encouraging and compare to those achieved in patients with regular femoral anatomy.