Is there a place for shelf acetabuloplasty in the management of adult acetabular dysplasia?

Effects of prior shelf procedure on subsequent conversion total hip arthroplasty

BACKGROUND

It is unclear if shelf acetabuloplasty provides adequate bone coverage when conversion total hip arthroplasty (THA) is required in patients with developmental dysplasia of the hip (DDH). We aimed to investigate the short-term results of conversion THA after shelf acetabuloplasty.

METHODS

Forty-six patients requiring conversion THAs after a prior shelf acetabuloplasty were matched to THAs for osteoarthritis secondary to Crowe I DDH in a 1:1 ratio. Surgical factors, clinical scores, cup placement, and bone coverage of the cup were evaluated.

RESULTS

The preoperative Japanese Orthopaedic Association (JOA) score and flexion range of motion (ROM) were lesser in the shelf group (JOA: 49.2 ± 22.4 vs. 60.1 ± 14.5, p < 0.01, flexion ROM: 69 ± 22.4 vs. 82.1 ± 17.5, p < 0.01). There were no significant differences in JOA (88.7 ± 8.7 vs. 92.1 ± 8.0,p = 0.053) and flexion ROM (93.5 ± 17.3° vs. 99.5 ± 8.0, p = 0.08) after the index THA.All cups in both groups were placed at the anatomical hip centre. The cup centre edge angle (cup CE) was significantly lower in the shelf group (21.3°vs. 28.4, p = 0.0011), and ratio of cup coverage over the cup was lower in the shelf group (77.0% vs. 86.9%, p < 0.0001). There was no significant difference in the number of cases where acetabular bone grafting was performed (87.0% vs. 80.4%, p = 0.46). The operative time tended to be longer in the shelf group (117 ± 30.3 min vs. 106.6 ± 25.3 min, p = 0.06), and there was no significant difference in intraoperative blood loss (294.3 ± 33.8 vs. 313.3 ± 25.9, p = 0.50).

CONCLUSION

Conversion THA after prior shelf acetabuloplasty provided encouraging short-term results with no major complications. Prior shelf acetabuloplasty did not complicate subsequent THA. Bone coverage of the acetabular component was inadequate in total hip arthroplasty, even with prior shelf acetabuloplasty.

Long-term results of a modified Spitzy shelf operation for hip dysplasia: 79 adults with a mean follow-up of 33 years

BACKGROUND

There is no consensus regarding the treatment of symptomatic hip dysplasia in adolescents and adults. Most previous studies have insufficient follow-up time.

AIM

The aim of this study was to assess the long-term outcome of a modified Spitzy shelf procedure.

METHODS

We reviewed 79 adults with 94 acetabular shelf operations between 1976 and 2000. Mean age at surgery was 33.7 years (range 13-54). Indication for surgery was acetabular dysplasia with or without hip pain. Outcome was evaluated using hip pain pre- and postoperatively and Kaplan-Meier survival analysis with conversion to total hip replacement (THR) as the endpoint.

RESULTS

Hip pain was reported in 84% of the hips preoperatively and in 21% one year postoperatively. 63 hips (65%) had undergone THR at a mean patient age of 54.3 years (range 29-76). The mean survival time from Spitzy operation to THR was 17.2 years (range 1-39). Survival was 86% at 10-year follow-up, 56% at 20-year follow-up, and 36% at 30-year follow-up. Predictors of THR were age at surgery ≥ 30 years and preoperative osteoarthritis (OA). The rate of complications was 12%, but most were mild to moderate.

CONCLUSIONS

The modified Spitzy shelf operation had a good effect on hip pain. The long-term survival with conversion to THR as the endpoint in hips without preoperative OA was similar to that reported after periacetabular osteotomy. This indicates that the shelf procedure may be a suitable option in adolescents and young adults with milder degrees of hip dysplasia without OA.

Modified triple pelvic osteotomy for residual acetabular dysplasia through double incisions: Technical note and review of short-term results

PURPOSE

To assess validity, safety, and efficacy of the modified triple pelvic osteotomy (TPO) approach for correction of residual acetabular dysplasia.

METHODS

This is a retrospective case series conducted on 15 hips in 15 patients from 2019 to 2023 with residual acetabular dysplasia treated by modified TPO as described by Tonnis with two modifications. The first modification is using a single medial incision for pubic and ischial cuts (the Vladimirov modification). The second modification is having the ischial cut closer to the acetabulum (Li modification) allowing free movement of the acetabular fragment for better femoral head coverage. The mean age at the time of surgery was 11.85 years, (range 8-23). Cases presenting were 10 males (66.7%) and 5 females (33.3%). The mean follow-up period was 36.533 months (24-60 months).

RESULTS

Our study revealed significant clinical and radiological improvement. The CE angle improved from a mean value of 10° (range 2-17) pre-operatively to 32.785° (range 18°-40°) post-operatively. The AI improved from a mean value of 32° pre-operatively to a mean value of 13.89° post-operatively. HHS increased from a preoperative mean value of 74.80° to a post-operative mean value of 90.67°. Also, there was a significant improvement in ROM (abduction and internal rotation). LLD improved from a mean value of 2.60 cm preoperatively to a mean value of 0.37 cm postoperatively. Delayed union was found in 3 cases. No cases of osteonecrosis or neurovascular complication were encountered in our study.

CONCLUSION

The modified TPO technique using dual incisions can be considered safe and effective, providing adequate coverage of the femoral head in acetabular dysplasia with less surgical time, satisfactory functional outcomes, and minimal complications.

LEVEL OF EVIDENCE

IV.

The modified Spitzy shelf acetabuloplasty for the dysplastic hip

Aims

Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty.

Methods

Between November 2000 and December 2016, we retrospectively evaluated 144 consecutive hip procedures in 122 patients a minimum of five years after undergoing modified Spitzy shelf acetabuloplasty for acetabular dysplasia including osteoarthritis (OA). Our follow-up rate was 92%. The mean age at time of surgery was 37 years (13 to 58), with a mean follow-up of 11 years (5 to 21). Advanced OA (Tönnis grade ≥ 2) was present preoperatively in 16 hips (11%). The preoperative lateral centre-edge angle ranged from -28° to 25°. Survival was determined by Kaplan-Meier analysis, using conversions to total hip arthroplasty as the endpoint. Risk factors for joint space narrowing less than 2 mm were analyzed using a Cox proportional hazards model.

Results

The mean Merle d'Aubigné clinical score improved from 11.6 points (6 to 17) preoperatively to 15.9 points (12 to 18) at the last follow-up. The survival rates were 95% (95% confidence interval (CI) 91 to 99) and 86% (95% CI 50 to 97) at ten and 15 years. Multivariate Cox regression identified three factors associated with radiological OA progression: age (hazard ratio (HR) 2.85, 95% CI 1.05 to 7.76; p = 0.0398), preoperative joint space (HR 2.41, 95% CI 1.35 to 4.29; p = 0.0029), and preoperative OA (HR 8.34, 95% CI 0.94 to 73.77; p = 0.0466).

Conclusion

Modified Spitzy shelf acetabuloplasty is an effective joint-preserving surgery with a wide range of potential indications.

Long-term outcomes of the hip shelf arthroplasty in adolescents and adults with residual hip dysplasia: a systematic review

Background and purpose - The shelf arthroplasty was the regular treatment for residual hip dysplasia before it was substituted by the peri-acetabular osteotomy. Yet, evidence regarding the survival of shelf arthroplasty surgery has never been systematically documented. Hence, we investigated the survival time of the shelf procedure until revision to THA in patients with primary hip dysplasia. Factors that influenced survival and complications were also examined, along with the accuracy of correcting radiographic parameters to characterize dysplasia.Material and methods - The inclusion criteria were studies of human adolescents and adults (> 16 years) with primary or congenital hip dysplasia who were treated with a shelf arthroplasty procedure. Data were extracted concerning patient characteristics, survival time, complications, operative techniques, and accuracy of correcting radiographic parameters.Results - Our inclusion criteria were applicable to 9 studies. The average postoperative Center-Edge Angle and Acetabular Head Index were mostly within target range, but large variations were common. Kaplan-Meier curves (endpoint: conversion to THA) varied between 37% at 20 years' follow-up and 72% at 35 years' follow-up. Clinical failures were commonly associated with pain and radiographic osteoarthritis. Only minor complications were reported with incidences between 17% and 32%.Interpretation - The shelf arthroplasty is capable of restoring normal radiographic hip parameters and is not associated with major complications. When carefully selected on minimal osteoarthritic changes, hip dysplasia patients with a closed triradiate cartilage may benefit from the shelf procedure with satisfactory survival rates. The importance of the shelf arthroplasty in relation to peri-acetabular osteotomies needs to be further (re)explored.

Three-Dimensional Navigation (O-arm) for Minimally Invasive Shelf Acetabuloplasty

Hip dysplasia is an important cause of osteoarthritis in young adults. For these patients, conservative treatment is an interesting alternative to arthroplasty. The current literature suggests better clinical and functional outcomes when shelf acetabuloplasty is performed for a moderate joint pinch (<50%) associated with an important external coverage defect of the acetabular cup (<25°). Compared with open surgical procedures, minimally invasive surgical techniques or arthroscopy tend to reduce morbidity. To date, the major intraoperative difficulty remains the positioning of the graft. This Technical Note aims to outline a minimally invasive shelf acetabuloplasty, with optimization of the position of the autologous iliac crest bone graft using 3-dimensional navigation.

Radiological results of Shelf acetabuloplasty in adolescent hip dysplasia with aspherical femoral head: how to get an ideal placement of the Shelf graft

Shelf acetabuloplasty continues to be effective in the prevention or delay of osteoarthritis in adolescent dysplastic hips. We aimed to evaluate the efficacy and to determine the correct level of the bone graft objectively. We retrospectively analyzed 16 hips underwent Shelf acetabuloplasty originated by Spitzy. The mean age at surgery was 15.3 years old with the mean caput index at 39.7%. The average follow-up was 11 years. The radiological evaluation was based on acetabular-head index (AHI) at preoperative and latest radiographs, acetabular-Shelf distance (ASD) and Shelf-head ratio at immediate postoperative and latest radiographs. The cutoff value for the ideal ASD was determined by receiver operating characteristic (ROC) and the Pearson correlation test used in statistical analysis to assess the relationship between ASD and Shelf graft resorption. Clinical evaluation was performed using Harris Hip Score (HHS) at the latest follow-up. The AHI was improved in all cases, from mean 56.9 to 91.0% (P < 0.001). The mean of ASD was 7 mm. In nine of the 16 cases, the Shelf graft was well united at the same level of the existing acetabulum with good continuity. The ROC curve showed the cutoff value for the ideal ASD was 6 mm. The Pearson correlation test also showed a positive relationship between ASD and Shelf graft resorption (P = 0.001). The average of HHS scores was 98.1 points. Both radiological and clinical results were acceptable. The ideal placement that keeps the shelf sufficient to bear the mechanical stress without bone resorption over time was at the level of 6 mm from the joint space. Level III - therapeutic study.

Residual hip dysplasia: is there a place for hip shelf operation?

PURPOSE

After modern acetabular osteotomies were introduced, hip shelf operations have become much less commonly used. The aims of this study were to assess the short-term and long-term outcome of a modified Spitzy shelf procedure and to compare the results with those of periacetabular osteotomy (PAO).

METHODS

In all, 44 patients (55 hips) with developmental dysplasia of the hip and residual dysplasia had a modified Spitzy shelf operation. Mean age at surgery was 13.2 years (8 to 22). Indication for surgery was a centre-edge angle < 20° with or without hip pain. Outcome was evaluated using duration of painless period and survival analysis with conversion to total hip arthroplasty (THA) as endpoints.

RESULTS

Preoperative hip pain was present in 46% of the hips and was more common in patients ≥ 12 years at surgery (p < 0.001). One year postoperatively, 93% of the hips were painless. Analysis of pain in hips with more than ten years follow-up showed a mean postoperative painless period of 20.0 years (0 to 49). In all, 44 hips (80%) had undergone THA at a mean patient age of 50.5 years (37 to 63). Mean survival of the shelf procedure (time from operation to THA) was 39.3 years (21 to 55).

CONCLUSIONS

The Spitzy operation had good short and long-term effects on hip pain and a 30-year survival (no THA) of 72% of the hips. These results compare favourably with those of PAO and indicate that there is still a place for the shelf procedure in older children and young adults.

Modified Shelf Acetabuloplasty Endoscopic Procedure With Allograft for Developmental Hip Dysplasia Treatment

Hip dysplasia has been identified as one of the leading causes of osteoarthritis. However, hip arthroscopy alone, in the setting of hip dysplasia, remains controversial. In borderline hip dysplasia, with lateral center-edge angle (LCEA) between 18° and 25°, good outcomes have been reported with appropriate capsular and labral management. However, in severe hip dysplasia, with LCEA below 18°, there is an acetabular bony structural deficiency that must be addressed. Even with the potential benefit of hip arthroscopy in addressing intra-articular injuries related to the instability, it cannot be used for soft-tissue procedures. Periacetabular osteotomy remains the gold standard to address that matter; however, its invasive nature along with the long recovery time leaves some patients unwilling to undergo this procedure. New minimally invasive endoscopic procedures, derived from open techniques, describe acetabular autologous bone grafting as an alternative. Donor-side morbidity is always a concern when using autografts; we believe that the use of bone allograft will decrease this potential issue and make the procedure itself less invasive. This Technical Note will describe a type of endoscopic shelf acetabuloplasty using an allograft iliac bone graft.

Painless period after Spitzy shelf operation for residual hip dysplasia-A long-term study of 47 children and young adults

Objective

To study the effects of the Spitzy shelf operation on hip pain.

Method

A modified Spitzy shelf procedure was performed in 60 hips with residual hip dysplasia. The mean age at surgery was 11.7 years (range 5.5-22.4 years).

Results

Twenty-one hips had pain preoperatively. One year postoperatively 57 hips (95%) were painless. The mean postoperative painless period in patients with >10 years follow-up was 24.1 years (range 5.0-51.5 years). The only independent predictor of long duration of painlessness was preoperative CE angle ≥10°.

Conclusion

The Spitzy procedure had favorable short- and long-term effects on hip pain.

Open treatment of dysplasia-other than PAO: does it have to be a PAO?

Hip dysplasia is a developmental disorder that results in anatomic abnormalities in which the acetabular coverage is insufficient. In the absence of severe degenerative changes, younger active patients with these symptomatic structural abnormalities are increasingly managed with joint-preserving operations. Historically there have been numerous reconstructive pelvic osteotomies. In recent years, the Bernese periacetabular osteotomy (PAO) has become the preferred osteotomy by many surgeons. Even so, as our understanding of the hip advances and new diagnostic and treatment techniques are developed, we sought to put a focus on the long-term results of augmental osteotomies and pelvic osteotomies other than the PAO, to see if any of these surgeries still have a place in the current algorithm of treatment for the dysplastic hip. As the longevity of the treatment is the focal point for joint preservation surgeries for the dysplastic hip, these authors have searched databases for articles in the English literature that reported results of long-term follow-up with a minimum of 11-year survivorship after surgical treatment of developmental dysplasia of the hip. Reconstruction osteotomies for the dysplastic hip are intended to restore normal hip anatomy and biomechanics, improve symptoms and prevent degenerative changes, in this manuscript each procedure is independently assessed on the ability to achieve these important characteristics.

Long-term results of a modified Spitzy shelf operation for residual hip dysplasia and subluxation. A fifty year follow-up study of fifty six children and young adults

PURPOSE

The purposes of this study were to establish long-term outcome of the Spitzy shelf-operation and evaluate whether the procedure would delay osteoarthritis.

METHODS

During 1954-1976, 56 patients (70 hips) underwent Spitzy shelf operation at a mean age of 11.9 years (5 to 22). Indications included residual hip dysplasia or subluxation with Centre-Edge angle < 20°. We used survival analysis with conversion to total hip replacements as end-point. For patients without total hip replacement, information was provided from case records and radiographs. Avascular necrosis was assessed in pre-Spitzy radiographs, when available. Kaplan-Meier product-limit method was used to estimate survival function of the Spitzy shelf operation. Survival was assessed by Cox regression. Univariable Cox regression was performed separately for each variable. Potential predictors (p-value < 0.10) were entered into a multivariable regression model; p-value < 0.05 was considered significant.

RESULTS

Mean survival of the shelf procedure was 39.9 years (21 to 53). Survival fell from 83 % 30 years post-operatively, to 22 % at 50 years. Fifty-three hips (76 %) had undergone total hip replacement at mean age of 49.4 years (33 to 64). Seventeen hips had not received total hip replacement, mean survival 47.9 years (39 to 53).

CONCLUSION

The study showed that Spitzy shelf-operation had satisfactory long-term outcome with hip-survival in almost 90 % at patient age 40 years. The results indicate that Spitzy shelf-operation postpone total hip replacement. We consider Spitzy shelf-operation a good alternative in patients above 8 years. In younger children the procedure is not recommended due to increased frequency of graft resorption.

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

BACKGROUND

The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described.

QUESTIONS/PURPOSES

The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction.

METHODS

The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle < 25° and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study's mean followup was 8 years (range, 2-18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0-96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software.

RESULTS

The 10-year survival rate was 93% (95% confidence interval [CI], 82%-100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0-54). Factors that influenced survival included joint congruency (100% versus 78%; 95% CI, 61%-96%; p = 0.03) and acetabular orientation correction achieved (AIpostoperative < 15° [100% versus 65%; 95% CI, 43-88; p < 0.001] and CEApostoperative 20° to 40° [100% versus 71.9%; 52.8-100; p < 0.001]). Better WOMAC scores were seen if postoperative AI < 15° (7 versus 25, p = 0.005) and CEA between 20° and 40° (7 versus 23, p = 0.005) were achieved. The chances of obtaining acetabular correction within this range improved after the 20(th) procedure (30% versus 70%, p = 0.008).

CONCLUSIONS

This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Total Hip Arthroplasty after Previous Acetabular Osteotomy: Comparison of Three Types of Acetabular Osteotomy

To compare surgical results of total hip arthroplasty (THA) following acetabular osteotomy, operative records of 13 hips following Chiari osteotomy (Chiari group), 22 hips following rotational periacetabular osteotomy (RAO; RAO group), 16 hips following shelf acetabuloplasty (Shelf group), and 2475 hips without previous osteotomy (Control group) were retrospectively reviewed. The operative time was significantly longer in the RAO group than in the Control group. Bulk bone augmentation was required more often in the Chiari and RAO groups than in the Control group. An early migration of the acetabular cup occurred in 2 hips in the RAO group. RAO made conversion to THA more complicated than did the Chiari osteotomy or the shelf acetabuloplasty.

The evolution and concepts of joint-preserving surgery of the hip

The use of joint-preserving surgery of the hip has been largely abandoned since the introduction of total hip replacement. However, with the modification of such techniques as pelvic osteotomy, and the introduction of intracapsular procedures such as surgical hip dislocation and arthroscopy, previously unexpected options for the surgical treatment of sequelae of childhood conditions, including developmental dysplasia of the hip, slipped upper femoral epiphysis and Perthes’ disease, have become available. Moreover, femoroacetabular impingement has been identified as a significant aetiological factor in the development of osteoarthritis in many hips previously considered to suffer from primary osteoarthritis.

As mechanical causes of degenerative joint disease are now recognised earlier in the disease process, these techniques may be used to decelerate or even prevent progression to osteoarthritis. We review the recent development of these concepts and the associated surgical techniques.

Cite this article: Bone Joint J 2014;96-B:5–18.

Bosworth hip shelf arthroplasty in adult dysplastic hips: ten to twenty three year results

PURPOSE

Hip shelf arthroplasty is currently considered to be a salvage procedure. The aim of the study is to present outcomes of Bosworth hip shelf arthroplasty in adolescent dysplastic hips with a minimum ten-year follow-up.

METHODS

The basic group comprised 25 hips in 18 patients with the mean age of 31 years (range, 16-52) at the time of operation. Subgroup A included 20 hips that were evaluated prior to operation as spherical, centric hips without osteoarthritic changes (acetabular dysplasia). The heterogeneous subgroup B comprised five hips. Of these, three hips were evaluated as aspheric, without osteoarthritic changes, and two hips as aspheric, with osteoarthritic changes of grade 2 according to Tönnis. In addition, two hips in subgroup B were evaluated as decentred (subluxated), one hip without and one hip with osteoarthritic changes. The mean follow-up was 15 years (range, ten-23).

RESULTS

In subgroup A, the positive effect of operation had lasted at the time of the final follow-up for ten to 22 years postoperatively (average follow-up 14 years) in 19 hips. Only one female patient, 46 years old at the time of operation, developed hip osteoarthritis within ten years, that was treated by THA. In subgroup B, a lasting positive effect of operation was recorded in two cases at the time of the final follow-up (12 and 15 years). The third female patient with an aspheric and decentred hip developed severe hip osteoarthritis 21 years after shelf procedure that was treated by THA. In two patients who had hip osteoarthritis already before the operation, the positive effect of the shelf procedure survived over 13 and 20 years. Although hip osteoarthritis progressed, THA was performed as late as 15 and 23 years after the shelf procedure. The mean Harris hip score in 21 hips with a still functional hip shelf was 68 (range, 56-82) before and 90 (range, 76-100) after the surgery.

CONCLUSION

The best outcomes of Bosworth hip shelf arthroplasty may be expected in a dysplastic spherical centred hip without osteoarthritic changes. In the presence of asphericity, decentration and osteoarthritic changes, neither the effect of the surgery nor its survival can be clearly predicted.

A shelf procedure at a follow-up of 75 years

Developmental dysplasia of the hip predisposes to premature degenerative hip disease. A number of operations have been described to improve acetabular cover and have achieved varying degrees of success. We present the case of an 84-year-old woman, who underwent a shelf procedure to reconstruct a dysplastic hip 75 years ago. To date, the shelf remains intact and the hip is asymptomatic. We believe this represents the longest documented outcome of any procedure to stabilise the hip.

Long-term outcomes of shelf acetabuloplasty for developmental dysplasia of the hip in adults: a minimum 20-year follow-up study

BACKGROUND

Shelf acetabuloplasty has been applied to secondary osteoarthritis of the hip due to congenital dislocation or acetabular dysplasia; however, there are few reports on the long-term outcomes of this operation. Here, we aimed to investigate the long-term effects of our shelf acetabuloplasty for developmental dysplasia of the hip in adults.

METHODS

Outcomes for 28 hips (7 with pre-arthrosis, 21 with initial stage of arthrosis) were retrospectively reviewed clinically and radiologically at a minimum of 20 years after operation. Mean age of the patients at operation was 34 years (range 17-54 years), and the mean follow-up period was 25 years (range 20-32 years).

RESULTS

Mean Japanese Orthopaedic Association hip score improved from 76 points preoperatively to 82 points, and mean pain score improved from 24 points preoperatively to 33 points at 20 years. Mean Sharp angle improved from 51° preoperatively to 37° immediately after the operation. Similarly, the mean center-edge angle improved from -4° to 38°, and the mean acetabulum head index improved from 52 to 99%. More than 50% of the hips showed no change in joint space width at 20 years. Survival rates were 100% at 10 years, 93% at 20 years and 71% at 32 years, with conversion to total hip replacement as the endpoint.

CONCLUSION

Long-term outcomes of our shelf acetabuloplasty were comparable to other reports, and the clinical outcomes and survivorship revealed positive long-term effects of our procedure over approximately 20 years.

Similar survival of eccentric rotational acetabular osteotomy in patients younger and older than 50 years

Pelvic osteotomy for middle-aged patients with hip dysplasia remains controversial. We asked whether pelvic osteotomy would yield lower Harris hip scores and survivorship in older patients than in younger patients. We compared patients younger than 50 years (n = 123) with patients 50 years or older (n = 41). At last followup, the mean Harris hip scores improved similarly in both groups: from 60 to 89 points in the older group and from 63 to 92 points in the younger group. However, in patients with bilateral surgery, the older group tended to have lower mean scores than the younger group (86 versus 93 points, respectively). Fifteen-year survivorship with a Harris hip score less than 80 points as the end point was similar in the two groups (71% in older patients and 81% in younger patients). In patients with bilateral surgery, the 15-year survivorship was lower in the older group (66% in older patients and 83% in younger patients). The data suggest eccentric rotational osteotomy for older patients can provide lasting function in most patients. However, prudent selection of patients is required for older patients with bilateral osteoarthritis.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Joint congruency in abduction before surgery as an indication for rotational acetabular osteotomy in early hip osteoarthritis

We conducted a retrospective review of the results of rotational acetabular osteotomy (RAO) procedures in 92 hips of 89 patients (81 females and eight males) with early-stage osteoarthritis. In this study, we discuss the indications for this surgery based on the preoperative congruency in abduction. The mean postoperative follow-up was 12.2 (7-19) years. The mean age at operation was 32.5 (13-54) years. Two hips with apparent technical failure were excluded. During follow-up, the osteoarthritic stage remained unchanged in 76 hips (good group) and progressed in 14 hips (poor group). Preoperative joint congruency in abduction was excellent in 20 hips, good in 62, and fair in eight. All eight hips with fair joint congruency showed progression to osteoarthritis at follow-up. Patients without good congruency in abduction may experience progression of osteoarthritis after RAO procedures even in early-stage osteoarthritis.

Vascularised iliac graft as a method of acetabular augmentation in subluxed hip in adolescents

This article presents the clinical experience of patients with a dysplasic subluxated hip treated with the same procedure involving a vascularised graft of iliac crest by sartorius muscle. This study was performed in three different centres, in two different countries, and in 31 patients with 37 hips (9 bilateral). All patients were clinically evaluated according to the Merle d Aubigne scale and radiological measuring of acetabular coverage, Sharp angle, and CE angle. Walking ability preoperatively was 4.87 and postoperatively 5.12, which was not statistically significant. Preoperative inclination acetabular angle was 59.0 degrees +/- 6.23 and postoperatively 37.5 degrees +/- 6.08 (P < 0.00001). Preoperative CE angle was -2.03 degrees +/- 13.5 and postoperatively was 41.0 degrees +/- 12.3 ( P < 0.00001). Index head acetabulum had a preoperative coverage of 48.3% +/- 13.0 and postoperatively 100.8% +/- 19.5. The head sphericity did not show any statistically significant difference in relation to the results. The results obtained were satisfactory from every point of view, making this the procedure of choice in the armamentarium to delay the need for a total joint as treatment of early osteoarthritis in young adults.

Slotted acetabular augmentation for the treatment of residual hip dysplasia in adults: early results of 12 patients

INTRODUCTION

Different pelvic osteotomies and various shelf procedures are used for the operative treatment of hip dysplasia. Slotted acetabular augmentation (SAA) is a well-established technique for the treatment of children and adolescents with hip dysplasia. It has not been widely accepted for treating hip dysplasia in adults although good outcomes have been reported with other augmentation techniques in adults.

MATERIALS AND METHODS

Since 1997, SAA has been used for the prevention of hip arthrosis in 14 dysplastic hips in 12 female patients. The median age at operation was 38.5 (17-42) years; the median follow-up period was 4 (1-8) years. The patients were evaluated on the basis of radiographic, biomechanical and clinical data prior to surgery and at follow-up.

RESULTS

The median centre-edge angle of Wiberg increased from 9 degrees (1-26) before the operation to 43 degrees (31-55) at the latest follow-up (P < 0.001). The median peak stress on the weight-bearing area of the hip, calculated mathematically, was reduced from 14.9 (6.3-28-1) MPa prior to the operation to 4.1 (3-6.1) MPa at the latest follow-up (P < 0.001); the median Harris Hip Score increased from 60 (45-98) points preoperatively to 93 (49-100) points at the follow-up (P < 0.001). There was no difference between the preoperative and follow-up hip joint-space width (P = 0.2).

CONCLUSION

There were no postoperative complications. In our series, the procedure has proved reliable and safe. Its advantages include symptomatic pain relief, adequate acetabular roof coverage and reduced peak stress on the weight bearing area of the hip. It can be used to postpone the development of hip arthrosis in adults with acetabular dysplasia.