Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia. Indications and long-term results

Abstract

Of 142 Chiari pelvic osteotomies for osteoarthritis in dysplastic hips, most performed by Chiari himself, we were able to review 82 and obtain information about 18 by questionnaire. All patients were over 30 years of age at operation; follow-up averaged 15.5 years. Twenty hips had undergone secondary total hip replacement. The outcome was good in 75%, fair in 9% and poor in 16%. High osteotomies all gave good results, and the result also depended on adequate medialisation. Statistics were worse for patients over 44 years of age at the time of operation. For osteoarthritis secondary to hip dysplasia, the Chiari pelvic osteotomy is an alternative procedure to early hip replacement. In contrast to intertrochanteric osteotomy, it has the advantage of facilitating the implantation of an acetabular prosthesis should arthroplasty become necessary at a later stage.

Factors influencing the outcome of Chiari pelvic osteotomy: a long-term follow-up

“…Our results, with 33.7% of patients developing degenerative change during follow-up, are similar to those of other authors. [3][4][5][6][7] In our study, clinical results at the last follow-up examination were satisfactory, with JOA scores above 80 points.…”

“…Chiari and others have considered the degree of medial displacement to be important. 2,6,11 We achieved medial displacement of 20% to 50% in most cases, but were unable to determine an ideal degree. We observed a reduction in the percentage of cases with progressive change when the postoperative CE angle was 30° to 60° or the medial displacement 40% to 60%, but this was not statistically significant.…”

“…5,9 Classical and high osteotomies have been reported to yield good results. 6,10,11 In five of the hips on which we performed a low osteotomy, there was partial osteonecrosis of the femoral head, possibly owing to high focal pressure in the area of the newly formed acetabular roof. Chiari and others have considered the degree of medial displacement to be important.…”

“…Although many factors, including the extent of the preoperative degenerative change, the age of the patient, the level of osteotomy and the degree of medial displacement are thought to have a role, 3,[6][7][8][9][10][11][12] which of these influence outcome is still not clear. We have reviewed the long-term clinical and radiological results of Chiari osteotomy, using survivorship analysis to examine some of the preoperative and operative factors which affect outcome.…”

Similar Survival of Eccentric Rotational Acetabular Osteotomy in Patients Younger and Older Than 50 Years

“…Previously, osteotomy was recommended mostly for younger persons, with the mean age in most earlier osteotomy series between 20 and 40 years [5,12,15,20,23]. Ninomiya and Tagawa [20] did not recommend osteotomy in elderly patients because of limping owing to weakness of the gluteus medius.…”