Satisfactory intermediate and long-term results of rotational acetabular osteotomy (RAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study is to examine the 30-year results of RAO. Between 1987 and 1994, we treated 49 patients (55 hips) with RAO for diagnosis of pre- OA or early-stage OA. Of those patients, 35 patients (43 hips) were available at a minimum of 28 years. The follow-up rate was 78.2% and the mean follow-up was 30.5 years. The mean age at the time of surgery was 34 years. Clinical evaluation was performed with the Merle d'Aubigne and Postel rating scale, and radiographic analyses included measurements of the center-edge angle, acetabular roof angle, and head lateralization index on preoperative, postoperative AP radiographs of the pelvis. Postoperative joint congruency was classified into four grades. The radiographic evidence of progression of OA was defined as the minimum joint space less than 2.5mm. The mean preoperative clinical score was 14.0, which improved to a mean of 15.3 at the time of the latest follow-up. The mean center-edge angle improved from 0.6° preoperatively to 34° postoperatively, the mean acetabular roof angle improved from 28.4°preoperatively to 1.0°postoperatively, the mean head lateralization index improved from 0.642 preoperatively to 0.59 postoperatively. Postoperative joint congruency was excellent in 11 hips, good in 29 hips, and fair in 3 hips. Nineteen patients (20 hips) had radiographic OA progression, and 10 patients (11 hips) were converted to THA. Kaplan-Meier survivorship analysis, with radiographic OA progression as the end point, predicted survival of 75.6% at 20 years and 48.8% at 30 years, and with THA conversion as the end point, 90.2% at 20 years and 71.2% at 30 years. The RAO is an effective surgical procedure for symptomatic dysplastic hips of pre- and early-stage OA and could change the natural history of the dysplastic hip.
Adolescent and young adult patients with a history of DDH and residual hip dysplasia tend to have an early presentation of symptoms. In these patients, a severe acetabular dysplasia, aspheric femoral head and/or high greater trochanter are often observed. We evaluated the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients younger than 21 years. We performed 492 RAOs for hip dysplasia from 1987 to 2017. In these cases, patients younger than 21 years at the time of surgery were 40 patients (46 hips). We evaluated 34 patients (40 hips, follow-up rate; 85%) retrospectively. There were 32 females and two males; their mean age at the time of surgery was 17.8 years (12–21). The mean follow-up period was 16.8 years (1–30). In eight hips, isolated RAO was not adequate to correct instability and/or congruency. For these hips, four varus femoral osteotomies, two valgus femoral osteotomies and two greater trochanter displacement were combined with RAO. The mean clinical score (JOA) was improved from 80 to 90 significantly at the final follow-up. The mean CE angle was improved from −3.4 (−35–10) degrees to 27 (8–42) degrees, acetabular roof angle from 30 (15–60) degrees to 6.7 (−3–30) degrees, head lateralization index from 0.665 (0.5–1.0) to 0.614 (0.429–0.7) postoperatively. Radiographic OA progression was observed in four hips, but no hip was converted to THA. The RAO is an effective technique for surgical correction of a relatively severe dysplastic hip in adolescent and young adults.
The transtrochanteric anterior rotational osteotomy (TRO) was developed by Sugioka as a joint-preserving procedure which prevents further deformity by transposing the necrotic area from a site of primary weight-bearing to a secondary area. We performed this procedure for children and young adults with various hip disorders. Between 1994 and 2015 we performed TROs on 12 joints in 12 patients with SCFE (4), pigmented villonodular synovitis (2), septic arthritis (1), FAI (1), hip dysplasia (1), femoral neck fracture (2) and postoperative RAO (1). The mean age at the time of surgery was 21 years (10–43) and the mean follow-up period was 8 years (1–22). The rotational directions of the femoral head were anterior (5) and posterior (7). Clinical assessment was undertaken using the system of Merle d'Aubigné and Postel, grading pain, mobility and walking ability with scores from 0 to 6. Radiographically bone regeneration and OA progression were estimated. The mean clinical score improved from 9.0 to 14.4 at final follow-up. Spur formation of femoral head was observed in 7 patients (58%). OA progression was in two patients (17%) and one patient was converted to THA 22 years after surgery. All cases with osteonecrosis in SCFE and femoral neck fracture showed remarkable bone regeneration. The TRO is a reliable joint-preserving procedure for various hip disorders in children and young adults.
The clinical results of total hip arthroplasty (THA) with a cementless prosthesis have been constantly improving due to progress in the area of stem design and surface finish. However, majority of stems are well-fixed with canal filling or diaphyseal fit, and cortical hypertrophy or metaphyseal bone atrophy has been often observed. Cementless Spotorno stem (CLS stem; Zimmer, Warsaw, USA) is a double-tapered rectangular straight stem. The purpose of this study is to investigate the mean 13 years' results of CLS stem and to evaluate the press-fit stability of CLS stem. Between 1999 and 2004, we treated 134 patients (142 hips) with CLS stem. Of those patients, 86 females (92 hips) and 13 males (14 hips), in total 99 patients (106 hips) were available at minimum of 11 years after surgery. At the time of follow-up, six females and five males were dead. The follow-up rate was 82% and the mean follow-up period was 13 years (SD; 20, range; 11–16). The mean age at the time of surgery was 65 years (SD; 10, range; 38–86). The mean body mass index was 24 (SD; 1.8, range; 19 to 28). Preoperative diagnoses were osteoarthritis in 92 patients, osteonecrosis in five patients, and rheumatoid arthritis in two patients. Majority of the patients were female because 84 patients of osteoarthritis suffered from hip dysplasia. For cementless acetabular reconstruction, APR cups (Zimmer, Warsaw, USA) were implanted in 10 hips, IOP cups (Zimmer, Warsaw, USA) in 22 hips, and Converge cups (Zimmer, Warsaw, USA) in 74 hips. As the liner of acetabular component, conventional UHMWPE (Sulene: Zimmer, Warsaw, USA) was used in APR cup and highly crosslinked UHMWPE (Durasul: Zimmer, Warsaw, USA) in IOP and Converge cups. The lipped liner was chosen in all cases, and lipped lesion was placed posteriorly. The radiographic stability of the femoral stem was determined by Engh's criteria. The ascertained period of spot welds was noted by Gruen zones on the femoral side. The presence of stress shielding, and subsidence was also evaluated.Background
Methods
Clione Anchored Replacement Prosthesis (CARP-H system) is a novel femoral implant for cementless fixation at the metaphysis of the proximal femur and preservation of cancellous bone of the femoral diaphysis is expected (Fig.1). We developed CARP-H system and started to use the prosthesis after the approval by Pharmaceuticals and Medical Devices Agency in 2012. This study examines the efficacy and short-term outcome of CARP-H system in a series of patients undergoing total hip arthroplasty (THA) or bipolar hemi-arthroplasty (BHA). Seventeen patients (17 hips) of osteonecrosis of the femoral head (ON) or osteoarthritis of the hip (OA) were included. The diagnoses were OA in 10 patients, and ON in 7 patients. The mean age at surgery was 55 years (35–62 years). The mean follow-up was 12 months (6–19 months). THA using CARP-H system was performed in 11 hips and BHA in 6 hips.Introduction
Patients and Methods
Since 2005, we have performed implantation of bone marrow-derived mononuclear cells for osteonecrosis of the femoral head in order to improve vascularization and bone repair. This study focused on early bone repair of osteonecrosis of the femoral head after transplantation of bone marrow-derived mononuclear cells (BMMNC). Twenty-two patients (30 joints) who had bilateral osteonecrosis followed for more than 2 years after BMMNC implantation were evaluated. Eight women and 14 men were included. Their mean age at surgery was 41 years (range, 18 to 64 years) and the mean follow-up period was 31 months. Pre-operative stage according to the ARCO classification was Stage 2 in 25 joints and Stage 3 in 5 joints. The mean volume ratio of osteonecrosis was 21%. For preparing BMMNC, about 700ml of bone marrow was aspirated from the ilium and centrifuged using a Spectra cell separator (Gambro). The BMMNC were seeded to interconnected porous calcium hydroxyapatite (IP-CHA) and implanted to the osteonecrotic lesion. As a control, cell-free IP-CHA was implanted for 8 patients (9 joints). A woman and 7 men were included. The mean age at surgery was 49 years (range, 28 to 73 years) and the mean follow-up period was 37 months. Preoperative stage was stage 2 in all patients. The mean volume ratio of osteonecrosis was 22%. At post-operative evaluations; progression of collapse, consolidation at reactive zone, post-operative course of volume rate of osteonecrosis, and bone absorption at osteonecrosis was assessed.Introduction
Patients and Methods
