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Title: [Proximal femoral varus osteotomy in adults after developmental dysplasia of the hip: long-term results].
Author: Rozkydal Z, Janíček P, Otiepka P.
Journal: Acta Chir Orthop Traumatol Cech; 2010; 77(6):489-93. PubMed ID: 21223829.
Abstract:
PURPOSE OF THE STUDY: The aim of this retrospective study was to assess the results of varus osteotomy of the proximal femur in adults with coxa valga after developmental dysplasia of the hip (DDH) and to evaluate the efficacy of this method. MATERIAL AND METHODS: Thirty hips in 28 patients treated by proximal femoral varus osteotomy in the period from 1983 to 1990 were evaluated. The indication for surgery involved coxa valga (145°-168°) with grade I- III of osteoarthritis and mild acetabular dysplasia. The patient group comprised twenty six women and two men with an average age of 28 years (18 to 42) at the time of surgery. The mean follow-up was 22 years (19 to 26). The preoperative radiographic examination included an AP view of the pelvis, AP views of the hip in neutral and in frog-leg position and AP views of the hip in 30° of abduction and neutral rotation. Varus osteotomy was indicated when the best position of the hip joint was achieved in abduction. The procedure was performed according to M. Müller. Hip assessment was based on the grade of osteoarthritis, CCD angle, Wiberg angle and AHI index. The results were statistically evaluated using the life table analysis of clinical survivorship of osteotomy and the Kaplan- Meier curve. Clinical failure was defined as conversion of osteotomy to total hip replacement (THR). RESULTS: At the latest follow-up of 22 years on the average, 18 patients (19 hips) still had osteotomy and 10 patients (11 hips) had undergone conversion to THR. The life table analysis showed the cumulative proportion of osteotomy with a clinical survivorship of 0.97 at 5 years, 0.75 at 10 and 15 years, and 0.68 at 20 and 25 years after surgery. The cumulative rate of clinical survivorship of osteotomy, as shown by the Kaplan-Meier curve, was 0.89 at 10 years, 0.75 at 20 years and 0.67 at 25 years after surgery. Nineteen patients were satisfied with the osteotomy outcome. The median of Harris hip scores in the patients with osteotomy was 48 points before surgery and 78 points at the latest follow-up. Conversion to THR in 10 patients (11 hips) was done at an average of 12 years after osteotomy. The median values before surgery and at the latest follow-up were: CCD angle, 158° and 118°; Wiberg angle, 13° and 20°; and AHI index, 56 % and 79 %, respectively. DISCUSSION: The prerequisite for a good result of proximal femoral varus osteotomy is the correct indication, i.e., younger age (18 to 30 years), a lower grade of osteoarthritis, mild dysplasia and a spherical shape of the femoral head. A disadvantage of the procedure is a shortening of the limb. The best indication for femoral varus osteotomy is unilateral coxa valga with a longer leg. CONCLUSIONS: This study shows favourable long-term results after isolated proximal femoral varus osteotomy in young adults with developmental dysplasia of the hip. A good function had been preserved in 18 of 28 DDH patients for an average of 22 years.

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