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Clinical Orthopaedics and Related Research®

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Open Access 01-04-2013 | Clinical Research

Less Invasive Rotational Acetabular Osteotomy for Hip Dysplasia

Authors: Masaaki Maruyama, MD, PhD, Shinji Wakabayashi, MD, PhD, Keiji Tensho, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 4/2013

Abstract

Background

Broad dissection with a long skin incision and detachment of the gluteus medius muscle performed for rotational acetabular osteotomy (RAO) can result in weakness in abduction strength of the hip. We use a surgical procedure for RAO that minimizes operative invasion of soft tissue and reduces incision length compared with conventional procedures.

Questions/Purposes

We evaluated the clinical results of this less-invasive RAO comparing it with the more-invasive prior procedure with respect to improvement in clinical hip scores and radiographic coverage and overall hip survival after the procedure.

Methods

In this less-invasive exposure, the medial gluteus muscle is retracted to expose the ilium without detachment from the iliac crest. Similarly, the rectus femoris muscle tendon is retracted, not excised. The lateral part of the osteotomized ilium is cut to form the bone graft instead of harvesting it from the outer cortical bone of the ilium. Between 2000 and 2009, 62 patients (71 hips) underwent this procedure. Twenty-eight hips had early-stage osteoarthritis and 43 had advanced-stage osteoarthritis. Mean patient age was 40 years at the time of surgery. We evaluated improvement in hip scores (Merle d’Aubigné-Postel, Japanese Orthopaedic Association) and radiographic appearance (lateral center-edge angle, Sharp’s angle, acetabular head index [AHI]). Kaplan-Meier survivorship analysis was performed. Mean followup was 5 years (range, 2.0–10.4 years).

Results

Clinical hip scores improved postoperatively. On average, lateral center-edge angle, Sharp’s angle, and AHI improved by 38°, 11°, and 42%, respectively. Predicted 10-year survival rates were 100% and 72% for hips with early- and advanced-stage osteoarthritis, respectively.

Conclusions

In hips with early-stage osteoarthritis treated by this less-invasive approach, no progression of osteoarthritis was documented and Trendelenburg gait was avoided. However, further investigation is necessary for hips with advanced-stage osteoarthritis.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Less Invasive Rotational Acetabular Osteotomy for Hip Dysplasia
Authors: Masaaki Maruyama, MD, PhD
Shinji Wakabayashi, MD, PhD
Keiji Tensho, MD
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 4/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2599-6

At a glance: The STEP trials

Springer Medicine

Less Invasive Rotational Acetabular Osteotomy for Hip Dysplasia

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Level of Evidence

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