Factors influencing the outcome of Chiari pelvic osteotomy: a long-term follow-up

Abstract

We have reviewed 103 of 126 Chiari osteotomies carried out in our department between 1956 and 1987. The cases were graded radiologically, using the Japanese Orthopaedic Association (JOA) system, into a pre/early osteoarthritis (OA) group and an advanced OA group. In the pre/early group there were 86 hips. The mean follow-up was for 17.1 years (4 to 37). Preoperatively, 51 hips had an average JOA clinical score of 78.6+/-8.4 points and the final mean JOA clinical score was 89.4+/-12.5 points. Advanced degenerative change developed in 33.7% and one hip required a total replacement arthroplasty (TRA). Chiari osteotomy alone, without accompanying intertrochanteric osteotomy, was performed on 62 hips. For these the median survival time was 26.0+/-2.5 years, using as the endpoint progression to advanced OA. Differences in survivorship curves related significantly to the severity of the preoperative OA, the shape of the femoral head and the level of osteotomy. In the advanced OA group, we followed up 17 hips for a mean of 16.2 years (1 to 27). Before operation, the mean JOA clinical score in 13 hips was 63.2+/-7.9 points and the final score 84.0+/-12.0 points. TRA was eventually carried out on four hips. Our findings suggest that the Chiari osteotomy remains radiologically effective for about 25 years. The procedure is best suited to subluxated hips with round or flat femoral heads and early or no degenerative change. Intra-articular osteotomy can lead to osteonecrosis, and should be avoided. In hips with advanced OA, the Chiari procedure creates an acetabulum which facilitates later TRA, and may delay the need for this procedure in younger patients.

A systematic review of the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty for treatment of hip disease

“…The description of prosthesis and fixation was less well ratedseven of the 18 published observational studies and the one published RCT did not adequately describe the procedure. 33,41,[48][49][50]53,55 One concern, relating to the description of the study sample, was that only five (26%) of the 19 published studies adequately described how the sample was selected, [6][7][8]24,45,46,48 and only six of the 19 (32%) published studies specified the inclusion and exclusion criteria. [6][7][8]43,45,46,48,52 None of the unpublished studies adequately described the method of selection of the study sample or specified the inclusion and exclusion criteria.…”

“…Of these, one was an RCT, 18 were single-intervention observational studies and three were systematic reviews which included THR studies. 1,30,38 Unpublished data from three industry submissions, [20][21][22] 43 12 on osteotomy [44][45][46][47][48][49][50][51][52][53][54][55] and one on arthrodesis. 33 No published studies relating to arthroscopy were included.…”

“…[44][45][46][47][48][49][50][51][52][53][54][55] The annual rates from each of the osteotomy studies included in the review ranged from 0.17% 54 to 2.69%. 44 These annual rates were combined by weighting the annual rate from each study by the size of the study.…”

Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH

“…Internal rotation* (°) 2 8± 19 (À50 to 70) [22][23][24][25][26][27][28][29][30][31][32][33][34] There were no patients without clinical examination or telephone followup. Clinical evaluations of the patients in both study groups were performed preoperatively and at the 10-year followups.…”

Dome osteotomy of the pelvis using a modified trochanteric osteotomy for acetabular dysplasia

“…However, others [11] did not find any correlation between preoperative degree of dysplasia and radiographic failure. Advance stage of osteoarthritis has also been identified as a cause of poor final clinical result [27]. In our series the eight patients who had fair or poor clinical results had significantly lower preoperative HHS as compared to the patients who had good or excellent results.…”