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

Abstract

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.

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

“…Migaud et al (2004) contained the cortical shelf by securing it with a small bent plate. The operation time of 55 minutes (35-75) was only documented Bartoníček et al (2012). Some studies combined the shelf arthroplasty in a minor part of their total population with a varus or valgus osteotomy of the proximal femur (8-27%) (Hamanishi et al 1992, Nishimatsu et al 2002, Hirose et al 2011.…”

“…For example, studies that included patients with incongruency and advanced osteoarthritis showed lower survival of the shelf arthroplasty (Migaud et al 2004, Fawzy et al 2005. Saito et al (1986), Berton et al (2010) and Bartoníček et al (2012) included only a few patients with severe osteoarthritis (8-22%), Nishimatsu et al (2002), Migaud et al (2004) and Fawzy et al (2005) included roughly half of their patients with severe osteoarthritis (42-57%), while Hirose et al (2011) and Tanaka et al (2018) included no patients with severe osteoarthritis. Differences were also found in inclusion of aspheric hips (Migaud et al 2004) or spheric hips (Bartoníček et al 2012), younger patients (Saito et al 1986, Hamanishi et al 1992, Nishimatsu et al 2002 or older patients (Berton et al 2010) even up to their 6th decade (Bartoníček et al 2012).…”

“…Surgical indication shelf Significant negative survival factors Bartoníček et al (2012) Dysplastic centered hip, without osteoarthritic changes, Aspherity, decentration, osteoarthritic changes. even in patients who are 60 years old Berton et al (2010) Age over 18 years, dysplastic hip, (0° < CE angle < 20°), Osteoarthrosis, CE angle < 0°, subluxation, labral tears hip centered with regard to the Shenton line (in positive-angle acetabular dysplasia) Fawzy et al 2005Mild/moderate dysplasia, minimal secondary arthritis Advanced osteoarthritis, moderate/severe incongruency Hamanishi et al (1992) Age under 30, pre-/early osteoarthritis, stable hip joint, Age above 30, bilateral dysplasia with intact or uninverted labrum Hirose et al (2011) Moderate dysplasia, without severe osteoarthritis; None found however, advanced osteoarthritis in combination with femoral valgus osteotomy might be possible Migaud et al (2004) If peri-acetabular osteotomy is not possible because of Severe dysplasia (CE angle < 15°), advanced stage severe subluxation or incongruency osteoarthrosis Nishimatsu et al (2002) Younger age (however not < 6 years)…”

“…Wrong shelf placement , Hirose et al 2011, Bartoníček et al 2012, Tanaka et al 2018. Nonweightbearing walking started at 2 days to 6 weeks, partial weightbearing started at 6 to 8 weeks and full weightbearing started at 10 weeks to 6 months.…”

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

“…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 , Fig 1). 1,2 Compared with open surgical procedures, minimally invasive surgical techniques or arthroscopy tend to reduce morbidity. This Technical Note aims to outline a minimally invasive shelf acetabuloplasty, inspired by that described by Chiron et al, 3 with optimization of the position of the autologous iliac crest bone graft using 3-dimensional navigation.…”