Ten year results of transtrochanteric valgus osteotomy with or without the shelf procedure

Abstract

Purpose The purpose of this study was to examine retrospectively the effectiveness of Sugioka's transtrochanteric valgus osteotomy (TVO) combined with the shelf procedure for patients who had advanced osteoarthritis (OA) of the hip with severe acetabular dysplasia. Methods Sixty-two hips in 61 patients were reviewed retrospectively between April 1993 and March 2009. Of these hips, 25 hips with the pre-operative acetabular head index (AHI) ≥ 60 % (single group) underwent a TVO, whereas the other 37 with AHI < 60 % (combined group) underwent a TVO combined with the shelf procedure. Results Using conversion to total hip arthroplasty as the endpoint, the Kaplan-Meier survival rates at ten years were calculated to be 85.5 % for the single group and 100 % for the combined group; there was a significant difference between the two groups (p<0.05, log-rank test). Similarly, calculated using progressive OA as the endpoint, survival rates at ten years were 69.5 % and 89.3 % respectively; there was also a significant difference between the two groups (p < 0.05, log-rank test). In the single group, the latest radiographic evaluations of the patients with the pre-operative AHI ≥ 70 % were significantly better than those of the patients with the pre-operative AHI < 70 % (P<0.05). Conclusion More satisfactory ten year results of TVO were obtained in cases that had a pre-operative AHI of ≥70 %, or where the shelf procedure was added. It is desirable that acetabuloplasty be added for patients with pre-operative AHI < 70 %.

Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip

“…Several authors have reported satisfactory results after valgus osteotomy for the treatment of advanced or end-stage osteoarthritis associated with acetabular dysplasia of the hip in young patients 3 - 6 , 12 - 20 . For patients with severe acetabular dysplasia in whom acetabular coverage remained insufficient after valgus osteotomy, some of those authors recommended additional acetabuloplasty operations such as a shelf procedure 12 , 13 , 21 or the Chiari pelvic osteotomy 3 in order to allow further lateralization of the affected femoral head. Our experience suggested that Chiari pelvic osteotomy was more advantageous because it allowed a larger weight-bearing surface to be created with the osteotomized proximal fragment and because it resulted in greater medialization of the hip center 22 - 30 than other procedures.…”