Is minimally invasive shelf acetabuloplasty in adults more reliable than periacetabular osteotomy? Long- term results

Abstract

This is a retrospective, single-operator study which hypothesised that shelf acetabuloplasty for acetabular dysplasia with a centre-edge angle of Wiberg between 0° and 15° and stage 1 or 2 osteoarthritis, has comparable results to periacetabular osteotomy with less severe complications. Patients and methods: 95 hips, mean follow-up of 12.8 years (4-26.4), 70.5% female (67/95), 29.5% male (28/95), mean age of 34.7 years (16-61 years). The surgical technique was minimally invasive, intermuscular between the posterior border of the tensor facia lata muscle and the anterior border of the gluteus medius muscle as described by Chiron in 2007. Survival curves were analysed using the Kaplan Meier method with the Log Rank test; Cox power test: 0.832. Results: Complications: 4 graft lyses (4.2%); 3 non-unions (3.1%); 56.8% (54/95) screw removal; no infection, no lateral femoral cutaneous nerve injury, all low-grade complications with no high-grade. Total hip replacements: 22.1% (21/95) of which 52.3% (11/21) were in the first 5 years. Age and gender had a significant impact on survival: under 30 years, 13.9% (6/43); over 30 years, 30% (15/50); under 25 years, 0% (0/13; mean follow-up 14.6 years; 9 -26); females, 26.8% (18/67), males, 10.7% (3/28). Survival: Overall (5 years: 90%, 10 years: 83,5%, 15 years: 77%); according to age: under 30 years (5 years: 95,3%, 10 years: 88,8%, 15 years: 84,3%), over 30 years (5 years: 84%, 10 years: 77,4%, 15 years: 69%), P-value 0.0004; according to gender: females (5 years: 86,3%, 10 years: 77,4%, 15 years: 68,9%), males (5 years: 96%, 10 years: 92,1%, 15 years: 92,1%), p-value: 0,0826; females over 30 years (5 years: 80,4%, 10 years: 75,1%, 15 years: 64,4%), females under 30 years (5 years: 91,6%, 10 years: 87,3%, 15 years: 80%), P-value: 0,1502 Survival rates were similar to those for peri acetabular arthroplasty, with no serious complications. Checking for any associated labral hip tears and arthroscopic treatment beforehand should improve the total hip replacement rate in the first 5 years. Ideal patients are young males and those at risk are females over 30 years of age, but with results that are still acceptable for group at risk which justify this minimally invasive procedure