Kompendium 2020 Forschung & Klinik

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49
Total Hip Arthroplasties
after Chiari Pelvic Osteotomy
Total hip arthroplasty (THA) in untreated developmental dysplasia
of the hip (DDH) poses a challenge on the surgeon, as unusual
anatomy, deficient acetabular bone stock, proximal femoral
malrotation, leg length differences, and soft tissue contractions
need to be considered 1-3 . Studies report higher complication rates
and worse outcomes for THA in patients with DDH compared to
primary osteoarthritis 1, 4 . Controversy exists whether prior pelvic
osteotomies have negative effects on subsequent THA.
Many authors have noted that a successful CPO would facilitate the initial
situation for THA by improving the coverage of the femoral head, thus increasing
the bone stock for implantation and fixation of the acetabular component,
and therefore possibly leading to better clinical results 5-8 . The aim of our study
was to carry out a retrospective analysis focusing on the long-term results
of THA after prior CPO and to look at the rate of and reasons for early THA
failures and revision surgery.
Materials and Methods
We screened patient charts and X-rays from all patients who had undergone
a CPO at our department between 1953 and 1986 and invited them to attend
a follow-up examination. Of this consecutive series of 1536 CPOs, follow-up
was completed in 405 patients, with 504 CPOs after a mean time of 36 years
(±8; range, 22-54 years) 9 . The mean age of all patients at CPO was 25.3 years
(±12.8; range, 1.8-55.3). All patients who had already undergone THA (301 hips;
60%) at the time of follow-up examination were included in the study cohort.
Study:
Schneider E, Stamm T, Schinhan
M, Peloschek P, Windhager R,
Chiari C. Total Hip Arthroplasty
after Previous Chiari Pelvic
Osteotomy-A Retrospective
Study of 301 Dysplastic Hips.
J Arthroplasty. 2020
Dec;35(12):3638–3643.
Study Population and Patient Assessment
The study cohort comprised 221 female (90%) and 24 male (10%) patients.
The mean time between CPO and THA was 24.5 years (±10; range,
1 months-45.9). Revision operations were conducted on average 9.6 years
(±6.1; range 4 months-25.4 years) after conversion THA. Patient’s average
age at the time of revision was 57.9 years (±10; range, 33.2-78.5).
Follow up was performed after an average time of 12.7 years (±7.4; range,
2 weeks-36.9 years) after THA.
66 patients (81 THAs) followed our invitation and underwent clinical examination,
179 patients (220 hips) were interviewed on the phone. Information
on former medical history, date and side of THA, peri- and postoperative
complications, and revision surgery was collected and the Harris Hip Score
(HHS) concerning pain and function was completed.