Takeshi Teratani

Periacetabular Osteotomy in Patients Fifty Years of Age or Older

BACKGROUND Periacetabular osteotomy has been established as an effective treatment for early or mild osteoarthritis caused by developmental dysplasia of the hip. However, the optimal method of surgical reconstruction for older patients remains controversial. The purpose of this retrospective study was to evaluate the clinical and radiographic results of a curved periacetabular osteotomy for the treatment of developmental dysplasia of the hip in patients fifty years of age or older. METHODS We evaluated forty-six consecutive hips in forty-two patients fifty years of age or older (the older group) who had developmental dysplasia of the hip and had undergone a curved periacetabular osteotomy between 1995 and 2006 with a minimum two-year follow-up period. The mean age was 54.6 years. We compared the clinical and radiographic results of this cohort with those of fifty hips in forty-four patients who were less than fifty years old (the younger group) and were managed with the same osteotomy. The mean age was 32.3 years. The patients were matched according to sex and Tönnis grade. Radiographic measurements included the center-edge angle, acetabular roof obliquity, acetabular head index, anterior center-edge angle, and head lateralization index. RESULTS The mean Harris hip score improved from 69.6 points preoperatively to 90.9 points postoperatively in the older group and from 71.1 points preoperatively to 91.8 points postoperatively in the younger group. There were no significant differences in any of the radiographic measurements between the two groups preoperatively or postoperatively. The Tönnis grades improved in two hips and progressed in three hips in the older group and improved in three hips and progressed in three hips in the younger group. CONCLUSIONS Satisfactory results can be obtained clinically and radiographically after curved periacetabular osteotomy in patients fifty years of age or older with Tönnis grade-1 or 2 osteoarthritis of the hip secondary to developmental dysplasia.

Periacetabular osteotomy in patients fifty years of age or older: surgical technique.

BACKGROUND Periacetabular osteotomy has been established as an effective treatment for early or mild osteoarthritis caused by developmental dysplasia of the hip. However, the optimal method of surgical reconstruction for older patients remains controversial. The purpose of this retrospective study was to evaluate the clinical and radiographic results of a curved periacetabular osteotomy for the treatment of developmental dysplasia of the hip in patients fifty years of age or older. METHODS We evaluated forty-six consecutive hips in forty-two patients fifty years of age or older (the older group) who had developmental dysplasia of the hip and had undergone a curved periacetabular osteotomy between 1995 and 2006 with a minimum two-year follow-up period. The mean age was 54.6 years. We compared the clinical and radiographic results of this cohort with those of fifty hips in forty-four patients who were less than fifty years old (the younger group) and were managed with the same osteotomy. The mean age was 32.3 years. The patients were matched according to sex and Tönnis grade. Radiographic measurements included the center-edge angle, acetabular roof obliquity, acetabular head index, anterior center-edge angle, and head lateralization index. RESULTS The mean Harris hip score improved from 69.6 points preoperatively to 90.9 points postoperatively in the older group and from 71.1 points preoperatively to 91.8 points postoperatively in the younger group. There were no significant differences in any of the radiographic measurements between the two groups preoperatively or postoperatively. The Tönnis grades improved in two hips and progressed in three hips in the older group and improved in three hips and progressed in three hips in the younger group. CONCLUSIONS Satisfactory results can be obtained clinically and radiographically after curved periacetabular osteotomy in patients fifty years of age or older with Tönnis grade-1 or 2 osteoarthritis of the hip secondary to developmental dysplasia.

Modified pubic osteotomy for medialization of the femoral head in periacetabular osteotomy: A retrospective study of 144 hips

Background and purpose Medial displacement of the femoral head reduces the force transmitted across the hip joint. Since 2005, we have performed a modified Ganzs osteotomy with curved periacetabular osteotomy (CPO) to obtain medialization of the femoral head. The modification involves cutting of the pubis at 30 degrees to the horizontal line. Here, we examined whether this modified CPO procedure medialized the femoral head more than the conventional CPO procedure. Patients and methods 69 patients (mean age 37 years, 72 hips) treated with the modified CPO procedure (the M group) were compared with 68 patients (mean age 38 years, 72 hips) previously treated with conventional CPO (the C group). All patients were operated because of dysplastic hips. We used radiographic measurements from anteroposterior radiographs. The magnitude of the resultant hip force normalized with respect to the body weight (R/WB) and hip contact joint stress (Pmax/ WB) was calculated in all cases. Results The average lateral center‐edge (CE) angle, acetabular roof obliquity (ARO), and acetabulum‐head index (AHI) improved in both groups. The CE angle, ARO, and AHI were similar in the 2 groups before and after surgery. Medialization of the femoral head was larger in the M group than in the C group (p < 0.001). The average value of the resultant hip force decreased from 3.2 to 2.9 in the M group and remained unchanged, at 3.1, in the C group. In addition, the average value of the peak contact stress decreased more in the M group (from 9.4 kPa/N to 3.4 kPa/N) than in the C group (from 9.1 kPa/N to 4.3 kPa/N). Interpretation In dysplastic hips, the modified CPO reduces the contact hip stress more than the conventional CPO because of better medialization of the femoral head.

Intraoperative Muscle Damage in Total Hip Arthroplasty

Tenderness in the medial and posterior thigh is sometimes observed during the early postoperative period after total hip arthroplasty (THA). In this study, the possible correlations of preoperative hip range of motion, surgical approach, and limb lengthening with postoperative muscle strain injury in THA were investigated. Sixty primary THA patients given the posterolateral approach or direct-lateral approach were examined. For comparison of the muscle strain injury in the 2 groups, we used magnetic resonance imaging. There were significant differences in postoperative thigh pain between cases in the posterolateral group with reduction of internal rotation and those with no reduction, and between cases in the direct-lateral group with reduction of external rotation and those with no reduction.