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Войти в исследования The Journal of arthroplasty · 2026
Outcomes of Rotational Acetabular Osteotomy Combined With Femoral Valgus Wedge Osteotomy for Osteoarthritis of the Hip: A Median 23-year Follow-Up Study of 47 Hips.
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Yoshikawa Yasushi, Okano Ichiro, Usui Yuki, Nishi Masanori, Nakamura Shota, Kudo Yoshifumi
Аннотация
BACKGROUND: Rotational acetabular osteotomy (RAO) combined with femoral valgus wedge osteotomy is a joint-preserving option for patients who have developmental dysplasia of the hip accompanied by femoral head deformity, as well as for those who have advanced secondary osteoarthritis (OA). This study aimed to identify significant predictors of long-term outcomes after this procedure in a cohort with a median 23-year follow-up, with conversion to total hip arthroplasty (THA) as the primary outcome and progression to end-stage OA as the secondary outcome.
METHODS: We retrospectively reviewed patients who have symptomatic secondary OA of Tönnis grade ≤ 2 accompanied by femoral head deformity who underwent RAO combined with femoral valgus wedge osteotomy at a single institution between 1986 and 2010. Survivorship was calculated with progression to Tönnis grade 3 and conversion to THA as the end points. Univariable Cox proportional hazards regression analyses were performed to evaluate prognostic factors, including patient characteristics, postoperative acetabular coverage, and femoral head morphology. There were two variables considered clinically relevant among those identified in the univariable analyses entered into a multivariable Cox proportional hazards model.
RESULTS: The final analysis included 45 patients and 47 hips. The 20-year survival rates were 67.2% with progression to Tönnis grade 3 and 85.9% with conversion to THA as the end points. In the univariable analyses, age at surgery, preoperative OA grade, and postoperative acetabular roof angle were identified as significant predictors of both end points. In the multivariable analysis including preoperative OA grade and postoperative acetabular roof angle selected based on the univariable analyses, both variables remained significant predictors of each end point.
CONCLUSIONS: In this cohort, the 20-year joint preservation rate without conversion to THA exceeded 80%. Preoperative Tönnis grade 2 and a larger postoperative acetabular roof angle were identified as significant predictors of progression to Tönnis grade 3 and conversion to THA.
LEVEL OF EVIDENCE: Level III.
METHODS: We retrospectively reviewed patients who have symptomatic secondary OA of Tönnis grade ≤ 2 accompanied by femoral head deformity who underwent RAO combined with femoral valgus wedge osteotomy at a single institution between 1986 and 2010. Survivorship was calculated with progression to Tönnis grade 3 and conversion to THA as the end points. Univariable Cox proportional hazards regression analyses were performed to evaluate prognostic factors, including patient characteristics, postoperative acetabular coverage, and femoral head morphology. There were two variables considered clinically relevant among those identified in the univariable analyses entered into a multivariable Cox proportional hazards model.
RESULTS: The final analysis included 45 patients and 47 hips. The 20-year survival rates were 67.2% with progression to Tönnis grade 3 and 85.9% with conversion to THA as the end points. In the univariable analyses, age at surgery, preoperative OA grade, and postoperative acetabular roof angle were identified as significant predictors of both end points. In the multivariable analysis including preoperative OA grade and postoperative acetabular roof angle selected based on the univariable analyses, both variables remained significant predictors of each end point.
CONCLUSIONS: In this cohort, the 20-year joint preservation rate without conversion to THA exceeded 80%. Preoperative Tönnis grade 2 and a larger postoperative acetabular roof angle were identified as significant predictors of progression to Tönnis grade 3 and conversion to THA.
LEVEL OF EVIDENCE: Level III.