Osteotomy in osteoarthritis of the hip-joint. A follow-up study

Osteoarthritis of the hip in patients under 60 years of age. A study of the importance of pain at rest as an indication for intertrochanteric osteotomy

Pain at rest with osteoarthritis of the hip may be due to increased intraosseous blood pressure, which falls immediately after an intertrochanteric osteotomy. Eighty-five consecutive hips from patients under 60 years of age at the time of operation were studied in order to evaluate if pain at rest was an indication for intertrochanteric osteotomy. Patients who operatively were predominantly in pain at rest had a significantly better prognosis than patients with a predominantly weight-bearing pain (P less than 0.05). Intertrochanteric osteotomy reduced pain for the group of patients with predominant pain at rest (n = 50) by 81%, 66%, and 56% at 5, 10, and 15 years respectively. In the group where weight-bearing pain was predominant (n = 35), the operation was a success in only 39% at 5 years and after.

Hypothesis: joints can heal

Although cartilage has a limited capacity for intrinsic repair, cells extrinsic to the cartilage can provide a mechanism for repair if the proper conditions exist. The new chondroid material produced, although not histologically or biochemically identical to mature hyaline articular cartilage, can nevertheless in many circumstances permit normal joint function and prevent further joint deterioration. The evidence suggests that joint healing results from establishing a source of cells, normalizing joint pressures, and encouraging joint motion. Much of the controversy surrounding the question of whether joints can heal results from a failure to view joint function, rather than cartilage appearance, as the most important component of the healing process, and to appreciate the significant role played by mechanical factors in promoting this response.

Intertrochanteric osteotomy without displacement fixed with an AO blade plate in the treatment of osteoarthritis of the hip

The results in 90 patients with osteoarthritis of the hip, treated by intertrochanteric osteotomy fixed with an AO blade plate, were analyzed 1-5 years after operation. The operation was performed without displacement of osteotomy, the aim being to produce bony union in the original position using the AO compression technique. With one exception, all osteotomies fused, but dislocation exceeding 0.5 cm resulted in four cases. The operation brought about relief from night pain in 88% of the patients and relief from weight-bearing pain in 41%. Abduction and adduction were the only movements that improved. The results were the same 1-2 and 4-5 years after the operation. Complications were rare, and the use of the compression method enabled the patients to get on by themselves the day after operation. This method is particularly well suited for young patients.

Osteotomy in osteoarthritis of the hip. A prospective study

Ninety-two patients (94 hips), who in 1971--1972 underwent intertrochanteric osteotomy for painful osteoarthritis of the hip, were assessed and graded according to a well-defined rating system immediately before operation and 1 and 5 years postoperatively. At the 1-year follow-up pain was absent or only slight in 73.5 per cent of the patients. Five years postoperatively this figure had decreased to 45.5 per cent; 41.5 per cent of the patients deteriorated between the two investigations. Nineteen patients had been reoperated upon and total hip replacement performed. It was not possible to predict the effect of the osteotomy from the preoperative clinical and roentgenological picture. Nor was the operative procedure (amount of medial displacement, varus angulation, tenotomy of the iliopsoas) found to have any influence on the results. Though the effect of the osteotomy is not as long-lasting as previously believed, it is concluded that it still has a place in the operative treatment of painful osteoarthritis of the hip in younger patients.