Abstract
Using a lateral approach during which the greater trochanter is excised, we performed domical pelvic osteotomy (modified chiari’s prpcedure) different from the original Chiarifs procedure. In a series of 176 modified Chiari pelvic osteotomies in 175 patients over 40 years old of the advanced coxarthrosis with acetabular dysplasia , in whom the postoperative courses were followed for more than 5 years (average, 6.9 years). JOA hip scores were improved in pain from 15.6 to 34.2 points and a total JOA score was improved from 55.7 to 76.5 points ,almost satisfactory results were obtained in 72.8% . In particular, markedly satisfactory results were obtained with respect to the improvement of pain in 84%. Radiographically, the coverage of the femoral head was markedly improved .The joint space was more dilated in 55% compared to that before surgery., however, the stage of coxarthrosis was more advanced in 18patients . In addition, the pathologic conditions of coxarthrosis had clinically deteriorated in 11 patients, resulting in treatment by total hip arthroplasty. As a result, there were more satisfactory results obtained, even in patients with advanced coxarthrosis, than expected.
Based on the results of this study, we considered that the Modified Chiari’s procedure is most effectively indicated for mature patients with the flat headed hip joints complicated by acetabular sclerosis. Therefore, we perform this procedure in combination with femoral valgus osteotomy. In contrast, satisfactory results cannot be expected from this combination therapy particularly in patients with the atrophic type roundheaded hip joints exhibiting poor acetabular sclerosis.
It is considered that the Modified Chiari’s procedure will be a useful treatment modality substituting for total hip arthroplasty even in mature patients, if applicable cases are carefully selected.
Subsequently, we radiographically evaluated the prognosis of the acetabulum based on its preoperative status. Levels of acetabular sclerosis were classified into the following 3 grades : : atrophic, nornopholic and hypertrophic type.After surgery, the joint space was dilated or maintained in all patients with the hypertrophic type hip joints. However, most patients with the atrophic type hip joints showed the poor prognoses because the stage of coxarthrosis was further advanced in 18% of them. Concerning the capital morphology before surgery, when the prognoses were evaluated based on the preoperative capital morphology, 96% of the proliferative headed hip joints were successfully treated, while only 83% of the round headed hip joints were successfully treated.
Even when the stage of coxarthrosis advanced during the prolonged period of follow-up and total hip arthroplasty is performed, it is the merit of this procedure that a larger size cup be applied without bone grafting.Because the matrix is formed satisfactorily in the newly generated acetabulum where osteotomy was performed.
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The present study evaluated the results of the Modified Chiari’s procedure performed mature patients with advanced coxarthrosis caused by acetabular dysplasia .
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Clinically, the JOA score was markedly improved in 84% patients.
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Radiographically, the coverage of the femoral head was more delated in 52%, compared to the joint space before surgery. However, the joint space narrowed in 18 patients, and total hip arthroplasty was performed in 6.3%.
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Modified Chiari method was considered to be a useful treatment modality that can sufficiently substitute for total hip arthroplasty in selected cases.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
