The Chiari pelvic osteotomy. A long-term review of clinical and radiographic results

Abstract

We have reviewed a series of 94 Chiari pelvic osteotomies carried out from 1966 to 1982. In 83 hips the indication for surgery had been pain, and of these patients 73 (88%) had appreciable relief within one year of operation. The other 11 hips were all in children and were painless; in them the osteotomy had successfully stabilised progressive subluxation of the hip. At review after a mean follow-up of 10 years (range, 2 to 18 years) 68 previously painful hips were reassessed. Although function of the hips had deteriorated slowly with time, four of the seven cases with 18 years' follow-up had good function and only minor symptoms. A detailed analysis of the radiographic changes produced by the Chiari osteotomy was made, using computerised analysis of variance. The beneficial effects of the osteotomy resulted from complex changes, among which the provision of a stable fulcrum for the hip seemed to be the most important.

Dome osteotomy of the pelvis using a modified trochanteric osteotomy for acetabular dysplasia

“…Moreover the mean range of movements did not decrease in any directions following the surgery. Our results agree with other reports [23] which concluded that the range of movement at the hip had not been impaired by the Chiari procedure, although progressive osteoarthritis did eventually reduce this range. However, some authors [24] have reported significant loss of internal rotation after Chairi osteotomy.…”

“…Hogh et al [23] reported that gait is [7], although this is not a universal finding [25]. In our series 14 patients were relieved of the preoperative antalgic gait, but two patients developed a Trendelenberg gait.…”

“…Injuries to the sciatic nerve and intrapelvic arterial damage have been reported as complications of this procedure [10,23]. There were no intraoperative complications in our series.…”

“…Rapid and continued pain relief has been reported as the most consistent effect following this operation [6]. Hogh et al [23] reported pain relief in 80% of the patients in the short term and the therapeutic effect of the osteotomy was evident in 50% of patients even after 18 years. Anwar et al [11] believed that the improvement of hip score after dome osteotomy is mainly due to pain relief and improved walking ability.…”

Dynamics of hip joint remodeling after Chiari osteotomy: 10 patients with neuromuscular disease followed for 8 years

“…However, pain associated with subluxation or dislocation was reduced in 9 of the patients. Chiari osteotomy has been used to treat hip subluxation and dislocation resulting from neitromusculur disorders (Otte 1969, Chiari 1974, Purath 1979, Bohler 1983, Root 1987, Thompson et al 1987, Osterkamp et al 1988, Gamble et al 1990, Pope et al 1994, Dietz and Knutson 1995, Niethard et al 1995a, Root et al 1995, DDH (Chiari 1974, Salvati and Wilson 1974, De Waal Malefjt et al 1982, Moll 1982, Bohler 1983, Fernandez et al 1984, Bohler et al 1985, Hogh and MacNicol 1987, Matsuno et al 1992, Rigo et al 1994, Niethard et al 1995a, Legg-Perthes' diseuse (Chiari 1974, Lack et al 1987, Thompson et al 1987, Robinson et al 1988, Mike and Bellyei 1989 and posttraumutic dysplasia (Trousdale and Ganz 1994). Osteotomy potentially improves femoral head coverage.…”