Outcome of Chiari pelvic osteotomy in adults: 90 hips with 2-15 years' follow-up

Migaud, Henri; Duquennoy, A.; Gougeon, F.; Fontaine, C.; Pasquier, Gilles

doi:10.3109/17453679508995505

Cited by 21 publications

(8 citation statements)

References 15 publications

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“…Regardless of the technique employed for an osteotomy, severe preoperative arthrosis is associated with worse clinical results (Kerschbaumer and Bauer 1979, Migaud et al 1995, Trousdale et al 1995, de Kleuver et al 1997, Hulet et al 1998. Therefore, one of the most relevant predictors of the clinical mid-term result after acetabular reorientation surgery is the grade of preoperative arthrosis.…”

Section: Discussionmentioning

confidence: 99%

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

Böhm¹,

Weber

2003

Acta Orthopaedica Scandinavica

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Section: Discussionmentioning

confidence: 99%

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

Böhm¹,

Weber

2003

Acta Orthopaedica Scandinavica

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“…3,[7][8][9] The point of contact between the acetabular roof and the femoral head remains unchanged after Chiari osteotomy. When we defined the endpoint as progression to advanced OA, the rate of survival of hips graded as preosteoarthritic was higher than those with early OA.…”

Section: Discussionmentioning

confidence: 99%

“…6,[8][9][10][11] Our findings showed that preoperative degenerative change, the shape of the femoral head and, most importantly, the level of osteotomy all affect longterm outcome. The Chiari osteotomy appears to be best suited to a dysplastic hip in which OA has not yet developed, even if the femoral head is deformed.…”

Section: Discussionmentioning

confidence: 99%

“…Although many factors, including the extent of the preoperative degenerative change, the age of the patient, the level of osteotomy and the degree of medial displacement are thought to have a role, 3,[6][7][8][9][10][11][12] which of these influence outcome is still not clear. We have reviewed the long-term clinical and radiological results of Chiari osteotomy, using survivorship analysis to examine some of the preoperative and operative factors which affect outcome.…”

mentioning

confidence: 99%

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

Ohashi

Hirohashi

Yamano

2000

The Journal of Bone and Joint Surgery. British volume

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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.

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“…3 Various studies report good mid-to long-term clinical results in 51% to 92% of hips. [4][5][6][7][8][9][10][11][12][13][14] Chiari originally described the technique for the osteotomy using an anterior approach. Subsequent reports have suggested that the trochanteric osteotomy is not required.…”

mentioning

confidence: 99%

Comparison of the surgical approaches for a Chiari pelvic osteotomy

Ito

Matsuno

Minami

2003

The Journal of Bone and Joint Surgery. British volume

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We present the mid- to long-term results of the Chiari pelvic osteotomy for dysplastic hips. We followed 135 hips in 129 patients, with a mean age at the time of surgery of 24 years, for a mean of 16.2 years We used the anterior iliofemoral approach without trochanteric osteotomy in the initial 31 hips. Thereafter, we used transtrochanteric approaches in an attempt to ensure that the osteotomy was at the most appropriate level, and to advance the high-riding greater trochanter distally. The next 79 hips therefore underwent a posterolateral approach and the most recent 25 hips an Ollier lateral U approach. The clinical result was excellent or good in 103 hips (77%). The outcome in 104 hips in which we used a transtrochanteric approach was superior, the osteotomy level was more appropriate and a Trendelenburg gait less common than in 31 hips in which we used an anterior approach. We therefore recommend the use of a transtrochanteric approach in order to ensure that the osteotomy is at an appropriate level and in order to achieve effective distal advancement of the high-riding greater trochanter.

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Outcome of Chiari pelvic osteotomy in adults: 90 hips with 2-15 years' follow-up

Cited by 21 publications

References 15 publications

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

Salter's innominate osteotomy for hip dysplasia in adolescents and young adults

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

Comparison of the surgical approaches for a Chiari pelvic osteotomy

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