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KMID : 1207720180100030299
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Clinics in Orthopedic Surgery
2018 Volume.10 No. 3 p.299 ~ p.306
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Radiographic Progression of Osteoarthritis after Rotational Acetabular Osteotomy: Minimum 10-Year Follow-up Outcome According to the Tonnis Grade
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Min Byung-Woo
Kang Chang-Soo
Lee Kyung-Jae
Bae Ki-Cheor
Cho Chul-Hyun
Choi Jung-Hoon
Sohn Hyuk-Joon
Sin Hong-Kwan
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Abstract
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Background: Although satisfactory mid- to long-term results of rotational acetabular osteotomy for early osteoarthritis secondary to acetabular dysplasia have been reported, there is still controversy about the long-term effects of this surgery in more advanced osteoarthritis. The purpose of this study was to investigate the radiographic progression of osteoarthritic changes after rotational acetabular osteotomy in acetabular dysplasia according to the preoperative Tonnis grade and evaluate its effects after minimum 10-year follow-up.
Methods: We performed 71 consecutive rotational acetabular osteotomies in 64 patients with symptomatic acetabular dysplasia between November 1984 and April 2005. Of these, 46 hips (four hips with Tonnis grade 0, 30 with grade 1, and 12 with grade 2) whose clinical and radiographic findings were available after minimum 10-year follow-up were evaluated in this study. The mean age at the time of surgery was 39.0 years (range, 18 to 62 years) and the average follow-up duration was 17.3 years (range, 10.0 to 27.7 years). Clinical and radiographic evaluations were performed according to the preoperative Tonnis grade.
Results: The average Harris hip score improved from 71.8 (range, 58 to 89) to 85.1 (range, 62 to 98). The radiographic parameters also improved in all Tonnis grades after the index surgery. Although the improvement of radiographic parameters was not different between preoperative Tonnis grades, the incidence of osteoarthritic progression was significantly different between grades (zero in Tonnis grade 0, four in Tonnis grade 1, and 10 in Tonnis grade 2; p < 0.001). The mean age at the time of surgery was also significantly older in osteoarthritic progression patients (p < 0.002). Kaplan-Meier survivorship analysis, with radiographic progression of osteoarthritis as the endpoint, predicted a 10-year survival rate of 100% in Tonnis grade 0, 85.7% in Tonnis grade 1, and 14.3% in Tonnis grade 2 (p < 0.001).
Conclusions: The outcome of rotational acetabular osteotomy in most hips with Tonnis grade 0 and 1 was satisfactory after an average of 17 years of follow-up. The incidence of osteoarthritic progression was higher in Tonnis grade 2 and older age. Our results support that early joint preserving procedure is essential in the case of symptomatic dysplastic hips.
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KEYWORD
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Hip, Acetabular dysplasia, Osteoarthritis, Rotational acetabular osteotomy
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