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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 23 - 23
1 Jun 2012
Cho YJ Kwak SJ Chun YS Rhyu KH Lee SM Yoo MC
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Purpose

To evaluate the clinical and radiologic midterm results of rotational acetabular osteotomy (RAO) in incongruent hip joints.

Material and Methods

A consecutive series of 15 hips in 14 patients who underwent RAO in incongruent hip joint were evaluated at an average follow-up of 52.3 months (range from 36 to 101 months). The average age at operation was 27 years (range from 12 to 38 years) old. The preoperative diagnoses were developmental dysplasia in 4 hips, sequelae of Legg-Calvé-Perthes disease in 8 hips, and multiple epiphyseal dysplasia in 3 hips. The RAO procedures were combined with a femoral valgus oseotomy in 10 hips, advance osteotomy of greater trochanter in 4 hips, derotational osteotomy in 2 hips. Clinically, Harris hip score, range of motion, leg length discrepancy(LLD) and hip joint pain were evaluated. Radiological changes of anterior and lateral center-edge(CE) angle, acetabular roof angle, acetabular head index(AHI), ratio of body weight moment arm to abductor moment arm, and a progression of osteoarthritis were analyzed.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 203 - 203
1 Mar 2013
Iwai S Kabata T Maeda T Kajino Y Kuroda K Fujita K Tsuchiya H
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Background. Rotational acetabular osteotomy (RAO) is an effective treatment option for symptomatic acetabular dysplasia. However, excessive lateral and anterior correction during the periacetabular osteotomy may lead to femoroacetabular impingement. We used preoperative planning software for total hip arthroplasty to perform femoroacetabular impingement simulations before and after rotational acetabular osteotomies. Methods. We evaluated 11 hips in 11 patients with available computed tomography taken before and after RAO. All cases were female and mean age at the time of surgery was 35.9 years. All cases were early stage osteoarthritis without obvious osteophytes or joint space narrowing. Radiographic analysis included the center-edge (CE) angle, Sharp's acetabular angle, the acetabular roof angle, the acetabular head index (AHI), cross-over sign, and posterior wall sign. Acetabular anteversion was measured at every 5 mm slice level in the femoral head using preoperative and postoperative computed tomography. Impingement simulations were performed using the preoperative planning software ZedHip (LEXI, Tokyo, Japan). In brief, we created a three-dimensional model. The range of motion which causes bone-to-bone impingement was evaluated in flexion (flex), abduction (abd), external rotation in flex 0°, and internal rotation in flex 90°. The lesions caused by impingement were evaluated. Results. In the radiographic measurements, the CE angle, Sharp's angle, acetabular roof angle, and AHI all indicated improved postoperative acetabular coverage. The cross-over sign was recognized pre- and postoperatively in each case. Acetabular retroversion appeared in one case before RAO and in three cases after RAO. Preoperatively, there was a tendency to reduce the acetabular anteverison angle in the hips from distal levels to proximal. In contrast, there was no postoperative difference in the acetabular anteversion angle at any level. In our simulation study, bone-to-bone impingement occurred in flex (preoperative/postoperative, 137°/114°), abd (73°/54°), external rotation in flex 0°(34°/43°), and internal rotation in flex 90°(70°/36°). Impingement occurred within internal rotation 45°in flexion 90°in two preoperative and eight postoperative cases. The impingement lesions were anterosuperior of the acetabulum in all cases. Discussion. It is easy to make and assess an impingement simulation using preoperative planning software, and our data suggest the simulation was helpful in a clinical setting, though there were some remaining problems such as approximation of the femoral head center and differences in femur movement between the simulation and reality. In the postoperative simulation there was a tendency to reduce the range of motion in flex, abd, and internal rotation in flex 90°. There was a correlation between acetabular anteversion angle and flex. Since impingement occurred within internal rotation 45°in flexion 90°in eight postoperative simulations, we consider there is a strong potential for an increase in femoroacetabular impingement after RAO


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_5 | Pages 37 - 37
1 Feb 2016
Hamada H Takao M Uemura K Sakai T Nishii T Sugano N
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Rotational acetabular osteotomy (RAO) for developmental dysplasia of the hip (DDH) may not restore normal hip range of motion (ROM) due to the inherent deformity of the hip and it may lead to femoro-acetabular impingement. The purpose of this study was to investigate morphological factors of the pelvis and femur influencing on simulated ROM after RAO with a fixed target for femoral head coverage. We retrospectively reviewed CT images of 52 DDHs with an average lateral centre edge angle (CEA) of 7.9° (−12° to 19°). After virtual RAO with 30° of lateral CEA and 55° of anterior CEA producing femoral head coverage similar to that of the normal hips, we measured simulated flexion ROM using pelvic and femoral computer models reconstructed from the CT images. Pelvic sagittal inclination, acetabular anteversion, lateral CEA, femoral neck anteversion, femoral neck shaft angle (FNSA), alpha angle and the position of the anterior inferior iliac spine (AIIS) were investigated as morphological factor. When the most prominent point of the AIIS existed more distally than the cranial tip of the acetabular joint line in a lateral view of the pelvis model in supine position, the subjects were defined as AIIS-Type1; the remaining subjects were defined as Type 2. There were 10 hips with Type 1 and 42 hips with Type 2 AIIS. The Kappa value of inter-observer reproducibility to classify AIIS was 0.82. Multiple regression analyses were performed to analyse the relationship between ROM and the morphological parameters. We also analysed the relationship between the probability of flexion ROM being less than 110° and the factors which influenced on flexion ROM. FNSA and AIIS-Type independently influenced on simulated flexion ROM after RAO (standard regression coefficient: −0.51 and 0.37, respectively. p< 0.001). The multiple correlation coefficient was 0.68. Flexion ROM after RAO with a fixed femoral head coverage similar to that of the normal hips ranged from 95° to 141° with an average of 121°±8°. The probability of ROM being less than 110° was significantly higher in subjects with AIIS-Type 1 than in those with Type 2 (odds ratio: 13.3, p<0.01). It was also significantly higher in subjects with more than 135° of FNSA than in those with less than 135° of FNSA (odds ratio: 9.5, p<0.05). FNSA and the type of AIIS influenced on flexion ROM after RAO with approximately 40° of variation in spite of a fixed target for femoral head coverage. A large FNSA and a distal positioning of AIIS were independently associated with smaller flexion ROM after RAO


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 210 - 210
1 Dec 2013
Yamaguchi J Terashima T
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[Introduction]

Total hip arthroplasty (THA) markedly improves pain, gait, and activities of daily living for most patients with osteoarthritis. However, pelvic osteotomy has been recommended for young and active patients with hip dysplasia, because THA in that population is associated with high rates of revision THA. The rotational acetabular osteotomy (RAO) of Ninomiya and Tagawa, and the eccentric rotational acetabular osteotomy of Hasegawa for hip dysplasia reportedly are successful in young and active patients. However, even after the surgery of RAO, osteoarthritis developed in some cases and leaded to the conversion to THA. The differences of bone quality of acetabulum have been reported between at the surgery of THA after RAO and at the surgery of primary THA. We should not discuss the results of these two THA equally. The purpose of this study is to report the results of THA after RAO.

[Patients and Methods]

We retrospectively reviewed 33 patients (37 hips) treated by total hip arthroplasty after rotational acetabular osteotomy between 1992 and 2012. Five cases were performed RAO with valgus osteotomy. At the time of THA surgery, the overall mean age of the patients was 57.5 years (range, 39–72 years). The average of follow-up period was 7.0 years (range, 8–258 months). One surgeon (TT) evaluated the hips clinically using the Japanese Orthopaedics Association (JOA) score. The radiographic measurements were performed by the other physician (JY) blinded to the clinical scores. Radiographical examination was performed using AP X-ray. We evaluated the presence of osteolysis and loosening of the implants. We evaluated the stability of stem implants using Engh classification and of cup implants using Hodgkinson classification.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 4 - 4
1 Jan 2016
Yang X Chen W Yu S Zhang Y Luo G Wang H Sheng P
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Objective

To investigate the biomechanical basis and report preliminary clinical efficacy of eccentric rotational acetabular osteotomy (ERAO) when treating developmental dysplasia of the hip (DDH).

Methods

Biomechanical model of the hip joint was established on cadaveric hips. After performed ERAO on the biomechanical model, we explored the impact of this surgery on biomechanics of the hip joint. Meanwhile, we reported postoperative follow-up cases who underwent ERAO in our hospital between November 2007 to July 2012. A total of 14 patients (15 hips) were reported, including 4 males and 10 females, mean age was 30 years old. Harris hip score was defined as clinical evaluation standard and radiographic assessment was based on the measurement and further comparison of pre- and post-operative AHI (Acetabular-head index), CE angle (Center-edge angle) and Sharp angle.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 314 - 314
1 Dec 2013
Fukui K Kaneuji A Sugimori T Ichiseki T Matsumoto T
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Background

The rotational acetabular osteotomy (RAO), that was developed in Japan, has been used successfully in patients with developmental dysplasia of the hip (DDH) (Figure 1). However there are some patients who are forced to have a total hip arthroplasty (THA) due to the progression of osteoarthritis. It is unknown if a RAO poses technical difficulties or increases the chances of complications if a THA must be performed afterwards becausethere is not much data on patients who underwent a THA after a previous RAO.

Objectives

The purpose of this study was to investigate the mid-term results of a THA after a RAO.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 27 - 27
1 May 2016
Sheng P Li Z Luo G Wang H Chen W Zhang Y Yang X
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Objective

To investigate the biomechanical mechanism and report preliminary clinical efficacy of eccentric rotational acetabular osteotomy (ERAO) when conduct treatment for developmental dysplasia of the hip (DDH).

Methods

Biomechanical model of the hip joint was established on six female cadaveric hips embalmed by formalin and stimulate ERAO was then performed on the model. Vertical force was loaded on the cadaveric spine from 0 N to 500 N and strain value on femoral head was measured preoperatively and postoperatively when loading force on spine reached the point of 100, 200, 300, 400 and 500 N. Stress value were then calculated base on the measurements. Besides, we reported postoperative follow up cases which were underwent ERAO to treat DDH in our hospital from July 2007 to October 2014. A total of 25 patients (26 hips) were reported, including 6 males and 19 females. Age varies from 11 to 57 years old, and the average age was 31 years old. Postoperative hip function was evaluated by Harris hip score and anteroposterior X⁃ray of pelvic was taken preoperatively and postoperatively to measure the Acetabular⁃head index (AHI), CE angle and Sharp angle.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XL | Pages 107 - 107
1 Sep 2012
Maruyama M
Full Access

BACKGROUND

Our modified procedure for rotational acetabular osteotomy (RAO) aimed to reduce operative invasion of soft tissue and to minimize incision length.

SURGICAL TECHNIQUE

A shortened skin incision (10–15 cm versus 20–30 cm in traditional RAO) is curved over greater trochanter and exposed by transtrochanteric approach. Medial gluteus muscle is retracted to expose the ilium without detachment from iliac crest. Similarly the rectus femoris muscle tendon was retracted, not excised, from the anterior inferior iliac spine. The lateral part of the osteotomized ilium is cut in lunate and trapezoid shape to form the bone graft instead of the outer cortical bone of the ilium.