Rotational acetabular osteotomy with a resection of the lateral edge of the acetabulum for the treatment of advanced coxarthrosis

Rotational acetabular osteotomy with resection of the capital drop and double floor for advanced osteoarthritis of the hip

Rotational acetabular osteotomy (RAO) is an established joint preservation technique for early stage osteoarthritis (OA). To extend the application of RAO for advanced OA with significant osteophyte formation, we added intraarticular procedures including removal of the double floor and the capital drop to create medialisation and better coverage of the femoral head.
The procedures were performed for seven joints with advanced OA. The average age of patients at surgery was 39 years. The follow-up periods ranged from five to 23 years. The capital drop was resected in five joints and both the capital drop and the double floor were removed in the other two joints.
The Japanese Orthopaedic Association Hip Score improved from 53 points before surgery to 69 at the latest follow-up. The range of flexion was decreased. The centre-edge angle, Sharp angle and acetabular head index were significantly improved. The femoral head was medialised 5 mm by surgery. Three joints (43%) showed progression of osteoarthritis. One joint (14%) needed replacement at seven years after RAO. Resection of the capital drop and curtain osteophyte with RAO improved joint congruity and medialisation of the femoral head, but decreased the range of motion of the joint due to increased bony coverage. Progression of degeneration of the joint is not preventable. We abandoned these procedures for advanced osteoarthritis of the hip joint especially in older patients who were suitable for replacement arthroplasty.

Joint chondrolysis

Although the disease was first described in the hip, reports of chondrolysis in nearly all diarthrodial joints have since emerged with considerable variations in the literature.Despite speculation among clinicians and researchers about the implicit causal pathways and etiologic contributors associated with chondrolysis, definitive answers remain elusive.The term chondrolysis has been applied to varied levels of joint cartilage destruction from focal chondral defects to diffuse cartilage loss, revealing a lack of consistency in the application of diagnostic criteria to guide differential disease classification.Differentiating between the various potential etiologies associated with chondrolysis provides opportunities for the prevention of the disease.

An unusual case of chondrolysis of the hip following excision of a torn acetabular labrum

Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of articular cartilage from both joint surfaces resulting in secondary joint space narrowing and stiffness. The authors report an unusual case of chondrolysis of the hip following mini open excision of a symptomatic acetabular labral tear. After a symptom-free period of 1 month following the excision of the torn labrum the patient started complaining of progressive hip pain and loss of movements. The rapid deterioration of the clinical functions and concentric reduction of joint space to less than 3 mm, consistent with chondrolysis, in the absence of evidence of any other hip pathology, led to the diagnosis. Intraoperatively extensive degeneration of joint cartilage was observed. Cementless total hip arthroplasty relieved the pain and allowed return to activities. The authors suspect that the use of thermal electrocautery during labral excision may have been responsible for the subsequent chondrolysis. The case is being reported not only for its rarity but also to alert treating surgeons of keeping the possibility if this condition in mind as it can pose a diagnostic dilemma.

Joint congruency in abduction before surgery as an indication for rotational acetabular osteotomy in early hip osteoarthritis

We conducted a retrospective review of the results of rotational acetabular osteotomy (RAO) procedures in 92 hips of 89 patients (81 females and eight males) with early-stage osteoarthritis. In this study, we discuss the indications for this surgery based on the preoperative congruency in abduction. The mean postoperative follow-up was 12.2 (7-19) years. The mean age at operation was 32.5 (13-54) years. Two hips with apparent technical failure were excluded. During follow-up, the osteoarthritic stage remained unchanged in 76 hips (good group) and progressed in 14 hips (poor group). Preoperative joint congruency in abduction was excellent in 20 hips, good in 62, and fair in eight. All eight hips with fair joint congruency showed progression to osteoarthritis at follow-up. Patients without good congruency in abduction may experience progression of osteoarthritis after RAO procedures even in early-stage osteoarthritis.