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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 2/2013

01-02-2013 | Clinical Research

Can a Triple Pelvic Osteotomy for Adult Symptomatic Hip Dysplasia Provide Relief of Symptoms for 25 Years?

Authors: Renee Anne van Stralen, MD, Gijs G. van Hellemondt, MD, PhD, Navin N. Ramrattan, MD, Enrico de Visser, MD, PhD, Marinus de Kleuver, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2013

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Abstract

Background

Many surgeons recommend pelvic osteotomy to treat symptomatic hip dysplasia in younger patients. We previously reported a cohort of patients at 10 and 15 years followup in which 65% of the patients showed no progression of osteoarthritis (OA).

Questions/purposes

The purposes of this study were to determine whether the triple osteotomy can provide (1) continuing pain relief and (2) function; and to determine the (3) incidence of OA and (4) number of patients undergoing THAs 23 years or more after triple osteotomy.

Methods

Between 1980 and 1987, 51 pelvic osteotomies were performed in 43 patients (38 females and five males; mean age, 28 years; range, 14–48 years). Followup was obtained for 40 patients (49 of 51 hips; 96%). Clinical evaluation, including pain, mobility, and ROM, was graded according to the subgroups of the modified scoring system of Merle d’Aubigné and Postel. The minimum followup was 23 years (mean, 25 years; range, 23–29 years).

Results

The mean VAS pain score increased from 27 mm to 31 mm at the last followup, but remained substantially lower than before surgery. The mean Merle d’Aubigné-Postel score improved from 13 preoperatively to 15 at a mean of 10 years followup but at last followup, the mean score had decreased to 14, thereby showing a trend to diminish. At 15 years followup, 20 patients showed signs of OA. At 25 years followup, 18 of 33 patients without THAs showed signs of OA (55%). Six patients (six hips) had undergone THAs at 15 years, increasing to 15 patients (16 hips) at 25 years.

Conclusion

While the triple osteotomy for symptomatic developmental dysplasia of the hip in young adults provides substantial pain relief and restores function in most patients, these results deteriorate over decades owing to the development of OA. Even in joints without preoperative OA, a THA cannot always be avoided. The triple osteotomy does not normalize the joint and the incidence of THA in this group of patients (32%) is much higher than in the general population.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Boere-Boonekamp MM, Kerkhoff TH, Schuil PB, Zielhuis GA. Early detection of developmental dysplasia of the hip in The Netherlands: the validity of a standardized assessment protocol in infants. Am J Public Health. 1998;88:285–288.PubMedCrossRef
2.
Broughton NS, Brougham DI, Cole WG, Menelaus MB. Reliability of radiographic measurements in the assessment of the child’s hip. J Bone Joint Surg Br. 1989;71:6–8.PubMed
3.
d’Aubigné RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.PubMed
4.
de Kleuver M, Kapitein PJ, Kooijman MA, van Limbeek J, Pavlov PW, Veth RP. Acetabular coverage of the femoral head after triple pelvic osteotomy: no relation to outcome in 51 hips followed for 8–15 years. Acta Orthop Scand. 1999;70:583–588.PubMedCrossRef
5.
de Kleuver M, Kooijman MA, Pavlov PW, Veth RP. Triple osteotomy of the pelvis for acetabular dysplasia: results at 8 to 15 years. J Bone Joint Surg Br. 1997;79:225–229.PubMedCrossRef
6.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications; a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.PubMedCrossRef
7.
Dungl P, Rejholec M, Chomiak J, Grill F. The role of triple pelvic osteotomy in therapy of residual hip dysplasia and sequel of AVN: long-term experience. Hip Int. 2007;17(suppl 5):S51–S64.PubMed
8.
Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI. Hip disease and the prognosis of total hip replacements: a review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–99. J Bone Joint Surg Br. 2001;83:579–586.PubMedCrossRef
9.
Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res. 2004;418:3–8.PubMedCrossRef
10.
Janssen D, Kalchschmidt K, Katthagen BD. Triple pelvic osteotomy as treatment for osteoarthritis secondary to developmental dysplasia of the hip. Int Orthop. 2009;33:1555–1559.PubMedCrossRef
11.
Kooijman MA, Pavlov PW. Triple osteotomy of the pelvis: a review of 51 cases. Clin Orthop Relat Res. 1990;255:133–137.PubMed
12.
Kotz R, Chiari C, Hofstaetter JG, Lunzer A, Peloschek P. Long-term experience with Chiari’s osteotomy. Clin Orthop Relat Res. 2009;467:2215–2220.PubMedCrossRef
13.
Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009;91:2113–2123.PubMedCrossRef
14.
Nakamura S, Ninomiya S, Takatori Y, Morimoto S, Umeyama T. Long-term outcome of rotational acetabular osteotomy: 145 hips followed for 10–23 years. Acta Orthop Scand. 1998;69:259–265.PubMedCrossRef
15.
Ninomiya S. Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult. Clin Orthop Relat Res. 1989;247:127–137.PubMed
16.
Shindo H, Igarashi H, Taneda H, Azuma H. Rotational acetabular osteotomy for severe dysplasia of the hip with a false acetabulum. J Bone Joint Surg Br. 1996;78:871–877.PubMedCrossRef
17.
Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.PubMedCrossRef
18.
Staheli LT, Chew DE. Slotted acetabular augmentation in childhood and adolescence. J Pediatr Orthop. 1992;12:569–580.PubMed
19.
Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin, Germany: Springer-Verlag; 1987.CrossRef
20.
Tönnis D, Arning A, Bloch M, Heinecke A, Kalchschmidt K. Triple pelvic osteotomy. J Pediatr Orthop B. 1994;3:54–67.CrossRef
21.
Tönnis D, Behrens K, Tscharani F. [A new technique of triple osteotomy for turning dysplastic acetabula in adolescents and adults (author’s transl)][in German]. Z Orthop Ihre Grenzgeb. 1981;119:253–265.PubMedCrossRef
22.
van Hellemondt GG, Sonneveld H, Schreuder MH, Kooijman MA, de Kleuver M. Triple osteotomy of the pelvis for acetabular dysplasia: results at a mean follow-up of 15 years. J Bone Joint Surg Br. 2005;87:911–915.PubMedCrossRef
23.
Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Acta Chir Scand. 1939;83 (suppl 58):7–135.
Metadata
Title
Can a Triple Pelvic Osteotomy for Adult Symptomatic Hip Dysplasia Provide Relief of Symptoms for 25 Years?
Authors
Renee Anne van Stralen, MD
Gijs G. van Hellemondt, MD, PhD
Navin N. Ramrattan, MD
Enrico de Visser, MD, PhD
Marinus de Kleuver, MD, PhD
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 2/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2701-0

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