Can a triple pelvic osteotomy for adult symptomatic hip dysplasia provide relief of symptoms for 25 years?

Renée van Stralen, Gijs G van Hellemondt, Navin Ramrattan, Enrico de Visser, Marinus de Kleuver

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background

Many surgeons recommend pelvic osteotomy to treat symptomatic hip dysplasia in younger patients. We previously reported a cohort of patients at 10 and 15 years followup in which 65% of the patients showed no progression of osteoarthritis (OA).

Questions/purposes

The purposes of this study were to determine whether the triple osteotomy can provide (1) continuing pain relief and (2) function; and to determine the (3) incidence of OA and (4) number of patients undergoing THAs 23 years or more after triple osteotomy.

Methods

Between 1980 and 1987, 51 pelvic osteotomies were performed in 43 patients (38 females and five males; mean age, 28 years; range, 14–48 years). Followup was obtained for 40 patients (49 of 51 hips; 96%). Clinical evaluation, including pain, mobility, and ROM, was graded according to the subgroups of the modified scoring system of Merle d’Aubigné and Postel. The minimum followup was 23 years (mean, 25 years; range, 23–29 years).

Results

The mean VAS pain score increased from 27 mm to 31 mm at the last followup, but remained substantially lower than before surgery. The mean Merle d’Aubigné-Postel score improved from 13 preoperatively to 15 at a mean of 10 years followup but at last followup, the mean score had decreased to 14, thereby showing a trend to diminish. At 15 years followup, 20 patients showed signs of OA. At 25 years followup, 18 of 33 patients without THAs showed signs of OA (55%). Six patients (six hips) had undergone THAs at 15 years, increasing to 15 patients (16 hips) at 25 years.

Conclusion

While the triple osteotomy for symptomatic developmental dysplasia of the hip in young adults provides substantial pain relief and restores function in most patients, these results deteriorate over decades owing to the development of OA. Even in joints without preoperative OA, a THA cannot always be avoided. The triple osteotomy does not normalize the joint and the incidence of THA in this group of patients (32%) is much higher than in the general population.
Original languageEnglish
Pages (from-to)584
JournalClinical Orthopaedics and Related Research
Volume471
Publication statusPublished - 2013
Externally publishedYes

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