Can a triple pelvic osteotomy for adult symptomatic hip dysplasia provide relief of symptoms for 25 years?
SourceClinical Orthopaedics and Related Research, 471, 2, (2013), pp. 584-90
Article / Letter to editor
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Clinical Orthopaedics and Related Research
SubjectNCEBP 10: Human Movement & Fatigue
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'Aubigne 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'Aubigne-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.
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