Abstract
The Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire, which is tailored to Japanese lifestyles, has recently been developed in Japan as a patient-reported outcome measure. In this study, combined valgus and Chiari osteotomy were evaluated using the JHEQ and JOA scores. The subjects were 42 hips of 39 patients with a mean age at surgery of 45.3 years. The mean follow-up period was 95.3 months. Radiological osteoarthritis stage, preoperative and postoperative JOA scores, JHEQ score at final follow-up, and patient dissatisfaction with hip joint status rated on a visual analog scale were evaluated. The factors that affected patient dissatisfaction were also identified using multiple regression analysis. Radiological osteoarthritis stage at final follow-up was either maintained or improved in 85.7%. The mean JOA score improved from 57.2 preoperatively to 78.7 at final follow-up. The JHEQ score at final follow-up, however, was low, at 43.3 points. Patients who were comparatively satisfied accounted for 47.6%. Of the JHEQ subscales, movement had the lowest scores, and this was the subscale that had the greatest effect on patient dissatisfaction. The present results suggest that the results of JOA score are inconsistent for postoperative patients' satisfaction after CVCO, and patient-based evaluation tool must also be used.
Highlights
In Japan, secondary osteoarthritis of the hip caused by developmental dysplasia of the hip (DDH) is the leading cause of osteoarthritis of the hip [1, 2]
The mean JOA score improved from 57.2 points preoperatively to 78.7 points at final follow-up (Figure 2(a)), but the total Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) score at final follow-up was lower, at 43.3 points (Figure 2(b)), lower than the JOA score
Actual subjective comments received from patients included a comparatively large proportion of movementrelated complaints that affected activity levels, such as back pain from limping or difference in leg length, and increased pain in the joints of the opposite leg following surgery. These findings suggest that the JOA score alone is insufficient for postoperative evaluation of combined valgus and Chiari osteotomy (CVCO), and another patient-based evaluation tool such as the JHEQ must be used
Summary
In Japan, secondary osteoarthritis of the hip caused by developmental dysplasia of the hip (DDH) is the leading cause of osteoarthritis of the hip [1, 2]. Improvements of the joint cartilage in DDH can be induced in many cases by the construction of biomechanical elements by osteotomy. Osteotomy has been proactively used to treat comparatively young patients, even if arthritic changes are advanced. Chiari osteotomy is a surgical procedure that reduces pain by improving coverage of the acetabulum and promoting reproduction of the fibrocartilage derived from the joint capsule [2,3,4]. Valgus osteotomy of the hip [5,6,7,8,9,10] is a widely performed procedure to achieve joint stability, repair, and regeneration using the proliferative changes of osteoarthritis. Since 2002, we have been performing combined valgus and Chiari osteotomy (CVCO) to treat patients with advanced or terminal-stage osteoarthritis of the hip whenever possible
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