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General Orthopaedics

SURGICAL RESULTS OF TOTAL HIP ARTHROPLASTY AFTER PREVIOUS ACETABULAR OSTEOTOMY

The International Society for Technology in Arthroplasty (ISTA), 28th Annual Congress, 2015. PART 4.



Abstract

Introduction

Acetabular osteotomy is considered to be an alternative treatment for acetabular dysplasia, particularly in adolescents and young adults because the long-term results of total hip arthroplasty (THA) in such patients remain controversial. To our knowledge, few reports have described the relationship between the types of osteotomies and surgical difficulty. We compared the operative and clinical results of THA following the 3 main types of acetabular osteotomies, including Chiari osteotomy, rotational periacetabular osteotomy (RAO), and shelf acetabuloplasty.

Methods

Operative records of 13 hips following Chiari osteotomy (Chiari group), 22 hips following RAO (RAO group), and 16 hips following shelf acetabuloplasty (Shelf group) were retrospectively reviewed. Operative records of 2475 primary THAs without previous osteotomies during the same period were reviewed as a control. The direct anterior approach was used for all hips

Results

The mean operative time was 57.7 ± 11.7 min in the Chiari group, 68.7 ± 25.7 min in the RAO group, 57.4 ± 20.5 min in the shelf group, and 50.6 ± 18.5 min in the Control group. The operative time was significantly longer in the RAO group than in the Control group (p < 0.05). The mean operative blood loss was 406 ± 277 g in the Chiari group, 439 ± 400 g in the RAO group, 377 ± 163 g in the Shelf group, and 379 ± 270 g in the Control group. Allogeneic blood transfusion was performed in 1 patient (4%) in the RAO group and in 26 patients (1%) in the Control group. Bulk bone augmentation to the acetabular defect was performed in 2 hips (15%) in the Chiari group, 7 hips (32%) in the RAO group, and 87 hips (3.5%) in the Control group. The requirement for bulk bone augmentation to the acetabular defect was significantly higher in the Chiari and RAO groups than in the Control group (p < 0.05). Aseptic loosening occurred in 2 cups in the RAO group and postoperative dislocation occurred in 1 hip in the Chiari group.

Conclusion

RAO made the conversion to THA complicated because of acetabular defects. Chiari osteotomy was less effective and shelf acetabuloplasty had no effect on surgical results of conversion THA.


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