Abstract
Background:Differences in clinical and radiographic results following total hip arthroplasty between failed wedge and curved varus osteotomy are unclear.Objective:To investigate differences in clinical and radiographic results following total hip arthroplasty in patients who exhibited failed wedge or curved varus osteotomy.Method:We performed 18 total hip arthroplasties after failed femoral varus osteotomy. Hips were divided into two groups: 14 had failed wedge varus osteotomy and four had failed curved varus osteotomy. Average ages at osteotomy and total hip arthroplasty were 27 years old (range, 10-46 years old) and 56 years old (range, 25-74 years old), respectively. The average duration of follow-up monitoring was 72.2 months (range, 54-91 months). Clinical and radiographic evaluations were completed for each group.Results:The Japanese Orthopaedic Association hip score of total hip arthroplasty after failed varus osteotomy significantly improved at the last follow-up in both groups. However, hip score at the last follow-up was significantly higher after failed curved varus osteotomy than after failed wedge varus osteotomy (p<0.01). Four hips that failed wedge varus osteotomy underwent subtrochanteric corrective osteotomy with total hip arthroplasty. Radiographic evaluation showed that three stems for total hip arthroplasty after failed wedge varus osteotomy were inserted in malposition, and all stems in total hip arthroplasty after failed curved varus osteotomy were inserted in the normal position.Conclusion:Surgeons performing femoral varus osteotomy should consider possible future conversion to total hip arthroplasty. Curved varus osteotomy is more suitable than wedge varus osteotomy for future conversion to total hip arthroplasty.
Highlights
Femoral varus osteotomy is a method to manage pre-arthritic and early arthritic hip conditions, including primary osteoarthritis, secondary osteoarthritis due to developmental dysplasia of the hip joint, and avascular necrosis; these can be challenging due to the relatively young patient age at presentation, high variation in structural deformities, and1874-3250/18 2018 Bentham OpenTotal Hip Arthroplasty (THA) Outcomes after Failed OsteotomyThe Open Orthopaedics Journal, 2018, Volume 12 209 increased risk of secondary hip osteoarthritis over time [1 - 8].Some patients experience a change in their hip disease after osteotomy, and several lines of evidence indicate good clinical results following femoral varus osteotomy [1 - 8]
There have been a few reports of THA after failed femoral varus osteotomy [13]; differences in clinical and radiographic results between patients who failed curved varus osteotomy and those who failed wedge varus osteotomy are unknown
We noted no significant differences between the two groups in terms of perioperative results; all four femoral subtrochanteric corrective osteotomies combined with THA were performed in the Wedge group (Table 2)
Summary
Femoral varus osteotomy is a method to manage pre-arthritic and early arthritic hip conditions, including primary osteoarthritis, secondary osteoarthritis due to developmental dysplasia of the hip joint, and avascular necrosis; these can be challenging due to the relatively young patient age at presentation, high variation in structural deformities, and1874-3250/18 2018 Bentham OpenTHA Outcomes after Failed OsteotomyThe Open Orthopaedics Journal, 2018, Volume 12 209 increased risk of secondary hip osteoarthritis over time [1 - 8].Some patients experience a change in their hip disease after osteotomy, and several lines of evidence indicate good clinical results following femoral varus osteotomy [1 - 8]. Femoral varus osteotomy does not always enable full recovery; some patients require further treatment with Total Hip Arthroplasty (THA) for hip osteoarthritis following femoral varus osteotomy. THA performed after intertrochanteric osteotomy for osteoarthritis is known to have higher perioperative and postoperative complication rates (17%-25%) than THA in patients without a history of osteotomy [10, 11]. Femoral varus osteotomy procedures have been described previously [1, 12] and can be divided into two groups: curved and wedge varus osteotomy. There have been a few reports of THA after failed femoral varus osteotomy [13]; differences in clinical and radiographic results between patients who failed curved varus osteotomy and those who failed wedge varus osteotomy are unknown. Differences in clinical and radiographic results following total hip arthroplasty between failed wedge and curved varus osteotomy are unclear
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