Osteotomía acetabular rotacional para la osteoartritis secundaria avanzada…

«Osteotomía acetabular rotacional para la osteoartritis secundaria avanzada de displasia de cadera.»

Yuji Yasunaga, MD, PhD1, Mitsuo Ochi, MD, PhD1, Hiroshi Terayama, MD1, Ryuji Tanaka, MD, PhD1, Takuma Yamasaki, MD, PhD1 and Yoshimasa Ishii, MD1

1 Department of Artificial Joints and Biomaterials (Y.Y. and Y.I.) and Department of Orthopaedic Surgery (M.O., H.T., R.T., and T.Y.), Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima City 734-8551, Japan. E-mail address for Y. Yasunaga: yasuyuji@hiroshima-u.ac.jp

Background: Satisfactory intermediate and long-term results of rotational acetabular osteotomy for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study was to examine the results of rotational acetabular osteotomy in patients with advanced osteoarthritis secondary to developmental dysplasia of the hip.

Methods: We performed a retrospective review of the results of rotational acetabular osteotomy in forty-three patients (forty-three hips). All of the patients had radiographic evidence of advanced-stage osteoarthritis, defined as narrowing of the joint space with cystic radiolucencies and small osteophytes according to the staging system of the Japanese Orthopaedic Association. Forty-one patients were female, and two were male. The mean age was 43.8 years at the time of surgery, and the mean duration of follow-up was 8.5 years. Clinical follow-up was performed with use of the system of Merle d’Aubigné and Postel. The center-edge angle, acetabular roof angle, head lateralization index, and minimum width of the joint space were measured on radiographs made preoperatively, postoperatively, and at the time of final follow-up. Postoperative joint congruency was classified into four grades.

Results: The mean preoperative Merle d’Aubigné clinical score was 13.3 points, which improved to a mean of 15.4 points at the time of the latest follow-up (p < 0.0001). The mean center-edge angle improved from 0.7° preoperatively to 29° at three months postoperatively (p < 0.0001), the mean acetabular roof angle improved from 30° to 11° (p < 0.0001), the mean head lateralization index improved from 0.69 to 0.65 (p < 0.01), and the mean minimum width of the joint space improved from 2.2 to 2.5 mm (p < 0.0003). Ten hips had radiographic evidence of progression of osteoarthritis. Kaplan-Meier survivorship analysis, with radiographic signs of progression of osteoarthritis as the end point, predicted a ten-year survival rate of 72.2%.

Conclusions: Rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip in properly selected patients can improve clinical scores and is associated with a lack of radiographic signs of progression of osteoarthritis in most patients.

The Journal of Bone and Joint Surgery (American). 2006;88:1915-1919.

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