Long-term results of a modified Spitzy shelf operation for hip dysplasia: 79 adults with a mean follow-up of 33 years.

Abstract

There is no consensus regarding the treatment of symptomatic hip dysplasia in adolescents and adults. Most previous studies have insufficient follow-up time. The aim of this study was to assess the long-term outcome of a modified Spitzy shelf procedure. We reviewed 79 adults with 94 acetabular shelf operations between 1976 and 2000. Mean age at surgery was 33.7years (range 13-54). Indication for surgery was acetabular dysplasia with or without hip pain. Outcome was evaluated using hip pain pre- and postoperatively and Kaplan-Meier survival analysis with conversion to total hip replacement (THR) as the endpoint. Hip pain was reported in 84% of the hips preoperatively and in 21% one year postoperatively. 63 hips (65%) had undergone THR at a mean patient age of 54.3years (range 29-76). The mean survival time from Spitzy operation to THR was 17.2years (range 1-39). Survival was 86% at 10-year follow-up, 56% at 20-year follow-up, and 36% at 30-year follow-up. Predictors of THR were age at surgery ≥ 30years and preoperative osteoarthritis (OA). The rate of complications was 12%, but most were mild to moderate. The modified Spitzy shelf operation had a good effect on hip pain. The long-term survival with conversion to THR as the endpoint in hips without preoperative OA was similar to that reported after periacetabular osteotomy. This indicates that the shelf procedure may be a suitable option in adolescents and young adults with milder degrees of hip dysplasia without OA.