Yuasa Takahito, Maezawa Katsuhiko, Kaneko Kazuo, Nozawa Masahiko
Department of Othropaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu city, Chiba, 279-0021, Japan.
Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Arch Orthop Trauma Surg. 2017 Apr;137(4):465-469. doi: 10.1007/s00402-017-2636-8. Epub 2017 Feb 14.
Rotational acetabular osteotomy (RAO), a joint-conserving surgery in which the femoral head coverage by autologous cartilage is improved to achieve joint stability, is one of the most common joint-conserving surgeries for acetabular dysplasia of the hip in adult patients. Favorable outcome of RAO for pre- and initial coxarthrosis has been reported with middle- to long-term observation; however, surgery should be selected for advanced coxarthrosis. The objective of this study was to investigate the long-term clinical outcomes and radiological arthritis changes in patients who were treated with RAO and could be followed for 15 years or longer, and to investigate the joint conservation rate by preoperative arthritis stage.
The subjects were 156 patients (178 joints) treated with rotational acetabular osteotomy alone between January 1989 and June 2000. Of those, 106 patients (115 joints) were retrospectively investigated. The mean age at the time of surgery was 41.4 years (14-60 years), and the mean duration of follow-up was 20 years and 4 months (15-26 years and 7 months).
There were no significant differences in the Harris hip score among the three groups before surgery; however, the score was significantly lower in the advanced than pre/initial coxarthrosis cases at final follow-up. The joint conservation rate with the end point defined as time of total hip arthroplasty was 70.4% at 20 years after surgery. By stage, joint conservation rates were 88.9, 78.9, and 59.3% in pre-, initial, and advanced coxarthrosis cases, respectively, demonstrating a significantly lower rate in the advanced coxarthrosis cases (p = 0.034). The mean time to conversion was 23, 14.5, and 13.7 years in the pre-, initial, and advanced coxarthrosis cases, respectively.
The outcome of rotational acetabular osteotomy in most hips with pre- or initial coxarthrosis was satisfactory. Rotational acetabular osteotomy is an effective surgery for treating symptomatic developmental dysplasia of the hip in selected patients.
髋臼旋转截骨术（RAO）是一种保关节手术，通过改善自体软骨对股骨头的覆盖来实现关节稳定，是成年患者髋关节髋臼发育不良最常见的保关节手术之一。对前期和初期髋关节炎患者行RAO的中期至长期观察结果显示预后良好；然而，对于晚期髋关节炎患者应选择其他手术方式。本研究的目的是调查接受RAO治疗且随访时间达15年或更长时间的患者的长期临床结果和影像学关节炎变化，并按术前关节炎分期调查关节保留率。
研究对象为1989年1月至2000年6月期间仅接受髋臼旋转截骨术治疗的156例患者（178个关节）。其中，对106例患者（115个关节）进行了回顾性研究。手术时的平均年龄为41.4岁（14 - 60岁），平均随访时间为20年零4个月（15 - 26年零7个月）。
三组患者术前Harris髋关节评分无显著差异；然而，在末次随访时，晚期髋关节炎患者的评分显著低于前期/初期髋关节炎患者。以全髋关节置换时间为终点，术后20年的关节保留率为70.4%。按分期来看，前期、初期和晚期髋关节炎患者的关节保留率分别为88.9%、78.9%和59.3%，晚期髋关节炎患者的关节保留率显著更低（p = 0.034）。前期、初期和晚期髋关节炎患者的平均转换时间分别为23年、14.5年和13.7年。
大多数前期或初期髋关节炎患者行髋臼旋转截骨术的结果令人满意。髋臼旋转截骨术是治疗特定患者有症状的发育性髋关节发育不良的有效手术。
