Acetabular Osteotomy Research Articles

Femoral neck trapdoor procedure and allograft for the chondroblastoma of the femoral head

The chondroblastoma is a kind of benign bone tumor which mainly arises from epiphyseal plate, including proximal parts of humerus, tibia and the proximal part of the femur. The reported incidence of femoral head chondroblastoma is rare, accounting for approximately 1–2% of bone tumors. The main treatments reported include acetabular osteotomies, osteochondral grafts, and vascularized fibular grafts. We present a case of femoral head chondroblastoma treated with a femoral neck trapdoor procedure and allograft. The hip function of this male patient recovered well, with no recurrence or complications found at 16 months follow-up. This procedure may be a sufficient and safe approach for the chondroblastoma of the femoral head.

Rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: a mean follow-up of 20years.

Rotational acetabular osteotomy (RAO), a joint-conserving surgery in which the femoral head coverage by autologous cartilage is improved to achieve joint stability, is one of the most common joint-conserving surgeries for acetabular dysplasia of the hip in adult patients. Favorable outcome of RAO for pre- and initial coxarthrosis has been reported with middle- to long-term observation; however, surgery should be selected for advanced coxarthrosis. The objective of this study was to investigate the long-term clinical outcomes and radiological arthritis changes in patients who were treated with RAO and could be followed for 15 years or longer, and to investigate the joint conservation rate by preoperative arthritis stage. The subjects were 156 patients (178 joints) treated with rotational acetabular osteotomy alone between January 1989 and June 2000. Of those, 106 patients (115 joints) were retrospectively investigated. The mean age at the time of surgery was 41.4 years (14-60 years), and the mean duration of follow-up was 20 years and 4 months (15-26 years and 7 months). There were no significant differences in the Harris hip score among the three groups before surgery; however, the score was significantly lower in the advanced than pre/initial coxarthrosis cases at final follow-up. The joint conservation rate with the end point defined as time of total hip arthroplasty was 70.4% at 20 years after surgery. By stage, joint conservation rates were 88.9, 78.9, and 59.3% in pre-, initial, and advanced coxarthrosis cases, respectively, demonstrating a significantly lower rate in the advanced coxarthrosis cases (p = 0.034). The mean time to conversion was 23, 14.5, and 13.7 years in the pre-, initial, and advanced coxarthrosis cases, respectively. The outcome of rotational acetabular osteotomy in most hips with pre- or initial coxarthrosis was satisfactory. Rotational acetabular osteotomy is an effective surgery for treating symptomatic developmental dysplasia of the hip in selected patients.

Rotational Acetabular Osteotomy.

Hip dysplasia is the most common cause of secondary osteoarthritis (OA). To prevent the early onset of secondary OA, Nishio's transposition osteotomy, Steel's triple osteotomy, Eppright's dial osteotomy, Wagner's spherical acetabular osteotomy, Tagawa's rotational acetabular osteotomy (RAO), and Ganz' periacetabular osteotomy (PAO) have been proposed. PAO and RAO are now commonly used in surgical treatment of symptomatic acetabular dysplasia in Europe, North America, and Asia. The aim of this paper is to present the followings: the patient selection criteria for RAO; the surgical technique of RAO; the long-term outcome of RAO; and the future perspectives.

A pre-operative predictive score for the outcome of eccentric rotational acetabular osteotomy in the treatment of acetabular dysplasia and early osteoarthritis of the hip in adults.

The influence of identifiable pre-operative factors on the outcome of eccentric rotational acetabular osteotomy (ERAO) is unknown. We aimed to determine the factors that might influence the outcome, in order to develop a scoring system for predicting the prognosis for patients undergoing this procedure. We reviewed 700 consecutive ERAOs in 54 men and 646 women with symptomatic acetabular dysplasia or early onset osteoarthritis (OA) of the hip, which were undertaken between September 1989 and March 2013. The patients' pre-operative background, clinical and radiological findings were examined retrospectively. Multivariate Cox regression analysis was performed using the time from the day of surgery to a conversion to total hip arthroplasty (THA) as an endpoint. A risk score was calculated to predict the prognosis for conversion to THA, and its predictive capacity was investigated. The congruity of the hip, age, the pre-operative minimum width of the joint space and range of abduction were identified as factors predicting conversion to THA. For three groups of patients (scoring 0 to 5, 6 to 7, and 8 to 9 points), the Kaplan-Meier event-free rates of survival at 15 years post-operatively for conversion to THA were 99.6%, 85.2% and 67.3%, respectively. These four pre-operative factors are easily measured and predict the prognosis for patients following ERAO. They may be used for decision making when offering surgical treatment to patients with acetabular dysplasia and early onset osteoarthritis. Cite this article: Bone Joint J 2016;98-B:1326-32.

Variations in the obturator artery around the obturator foramen assessed by three-dimensional computed tomographic angiography and prevention of vascular-related complications in rotational acetabular osteotomy.

The aims of this study were (1) to evaluate the anatomical variations and locations of the obturator artery at the obturator foramen using computed tomographic (CT) angiography images and (2) to evaluate the pubic osteotomy site in rotational acetabular osteotomy using postoperative CT images in order to assess the relationship between the obturator artery and the pubic osteotomy site. We examined a total of 196 hips in 98 consecutive Japanese patients for aim (1), and 38 consecutive patients who underwent rotational acetabular osteotomy for aim (2). The prevalence of arterial anastomosis of the obturator artery (corona mortis) was 14.3%, with the obturator artery being located closer to the superior pubic ramus and the osteotomy site in these subjects. Extensive care should be taken during rotational acetabular osteotomy in patients showing variations of the obturator artery with corona mortis.

CORR Insights(®): Rotational Acetabular Osteotomy for Pre- and Early Osteoarthritis Secondary to Dysplasia Provides Durable Results at 20 Years.

CORR Insights(®): Rotational Acetabular Osteotomy for Pre- and Early Osteoarthritis Secondary to Dysplasia Provides Durable Results at 20 Years.

Curtain osteophytes are one of the risk factors for the poor outcome of rotational acetabular osteotomy.

Rotational acetabular osteotomy (RAO) is one of the surgical procedures for painful dysplastic hips. Although several risk factors for poor outcome of RAO have been reported, the presence of a curtain osteophyte in the acetabulum has not been evaluated as a possible risk factor. This study aimed to analyze the risk factors affecting the outcome of RAO and to clarify whether curtain osteophytes are one of the risk factors. We retrospectively analyzed 87 hips in 78 patients with a mean age of 36 (range, 13-54) years. The mean follow-up period was 8.3 (range, 2.1-19.5) years. The radiographic severity of osteoarthritis was classified into four stages: pre-arthrosis, initial stage, advanced stage, and terminal stage. The Japanese Orthopaedic Association (JOA) hip score was used for clinical evaluation. Poor outcome was defined as a hip with a JOA score < 80 points or terminal-stage osteoarthritis at final follow-up. Several factors were evaluated by logistic regression analysis. At final follow-up, ten hips had a JOA score < 80 and nine hips had progressed to terminal-stage osteoarthritis. Since five hips had a JOA score < 80 as well as terminal-stage osteoarthritis, a total of 14 hips were determined to have poor outcome. An additional tenyears of age at surgery, pre-operative minimal joint space < 2mm, presence of a curtain osteophyte, and fair/poor congruency in abduction were identified as significant risk factors for poor outcome of RAO. Hips with curtain osteophyte should be evaluated carefully before RAO.

Rotational Acetabular Osteotomy for Pre- and Early Osteoarthritis Secondary to Dysplasia Provides Durable Results at 20Years.

Hip dysplasia is a common cause of secondary osteoarthritis (OA). Periacetabular osteotomy or rotational acetabular osteotomy has been used as joint-preserving procedures. However, only a few reports of long-term results with these operations have been reported. (1) Would satisfactory clinical and radiographic outcomes be maintained at a mean duration of 20 years after rotational acetabular osteotomy for pre- and early-stage OA; and (2) could we identify risk factors for radiographic progression of OA? Between 1987 and 2001, we treated 159 patients (173 hips) with rotational acetabular osteotomies for the diagnosis of pre-OA or early-stage OA according to the technique of Ninomiya and Tagawa. During that period, our general indications for this approach were age younger than 60 years, center-edge angle less than 20°, and improved femoral head coverage and joint congruency on preoperative AP plain radiographs of the hip in abduction; we did not use this approach when joint congruency was not improved or no widening of the joint space was noted on preoperative AP plain radiographs of the hip in abduction. Of those patients, 21 patients with pre-OA (followup rate: 84% [27 hips]) and 110 patients in the early-stage group (followup rate: 82% [118 hips]) were available at a minimum of 15 years for a total patient group of 131 (followup rate: 82% [145 hips]). The mean age at the time of surgery was 22 years in the pre-OA group and 38 years in the early-stage group. The mean followup was 21 years in the pre-OA group and 20 years in the early-stage group. Clinical evaluation was performed with the Merle d'Aubigne and Postel rating scale, and radiographic analyses included measurements of the center-edge angle, acetabular roof angle, and head lateralization index on preoperative and postoperative AP radiographs of the pelvis. Postoperative joint congruency was also evaluated. The cumulative probabilities of radiographic signs of OA progression were estimated with use of the Kaplan-Meier product-limited method and parametric survivorship analysis using the Cox proportional-hazards model was used to determine risk factors for radiographic OA progression. The mean clinical score improved very slightly, from 15 (SD, 0.8) to 18 (SD, 1.1) (95% confidence interval [CI], -2.9 to -2.0; p < 0.001) in the pre-OA group and from 15 (SD, 1.0) to 16 (SD, 2.1) (95% CI, -2.0 to -1.2; p < 0.001) in the early-stage group at followup. Fourteen patients (15 hips) including one pre-OA patient (one hip) and 13 early-stage patients (14 hips) experienced worsening of their Merle d'Aubigne and Postel score, from a mean of 15 (SD, 0.9) to 12 (SD, 1.6) (95% CI, 1.8-3.3; p < 0.001). Eight patients (nine hips) with early-stage OA preoperatively underwent total hip arthroplasty at a mean duration after rotational acetabular osteotomy of 20 (SD, 2.5) years. Radiographic indices were improved after surgery in both groups. Radiographic progression of OA occurred in 24 patients (25 hips). Kaplan-Meier survivorship analysis, with radiographic signs of progression of OA as the endpoint, predicted survival of 96% (95% CI, 89%-100%) at 10 years and 20 years in the pre-OA group. For the early-stage group, we found survivorship of 89% (95% CI, 83%-95%) at 10 years and 78% (95% CI, 69%-87%) at 20 years. We identified two factors associated with poor outcome: fair (rather than excellent and good) postoperative joint congruency (hazard ratio, 12.1; 95% CI, 3.8-39; p < 0.001) and age older than 46 years at the time of surgery (hazard ratio, 4.6; 95% CI, 1.9-11; p < 0.01). Rotational acetabular osteotomy is an effective surgical procedure for symptomatic dysplastic hips in pre- and early-stage OA, and it prevented radiographic OA progression and maintained hip function at a mean 20 years after surgery. Level IV, therapeutic study.

Preoperative prognosis score is a useful tool regarding eccentric rotational acetabular osteotomy in patients with acetabular dysplasia.

It is unknown how possible preoperative factors influence the postoperative outcome of eccentric rotational acetabular osteotomy (ERAO). We aimed to determine these factors and to develop a scoring system for predicting the prognosis after ERAO in patients with symptomatic hip dysplasia. We included 700 patients (54 men, 646 women) who underwent ERAO during September 1989 to March 2013. The patients' clinical background, preoperative clinical findings, and preoperative imaging findings were examined retrospectively. Univariate and multivariate Cox regression were performed using the time from the day of surgery to a Harris hip score (HHS) <80 as an endpoint. A failure score was defined to predict the prognosis for an HHS <80, and its predictive capacity was assessed. Ninety patients had an HHS <80. Forty-two patients underwent conversion to total hip arthroplasty (THA) after their HHS decreased to <80. Five factors were identified in relation to an HHS <80: a history of congenital dislocation of the hip, joint congruity, body mass index, the preoperative minimum joint space width, and the preoperative abduction range of motion. We estimated the weight of each factor using the results of multivariate Cox regression, and the outcome prediction scoring was obtained (0-17 points). For three groups of patients (total points of each factors: 0-5, 6-9, and ≥10 points), the Kaplan-Meier event-free survival rates at 15 years postoperatively for an HHS <80 were 97%, 81%, and 55%, respectively; the survival rates for THA conversion using this prediction scoring were 99%, 96%, and 85%, respectively. Five preoperative factors can easily and clearly predict the prognosis following ERAO. The prognosis score may be a useful tool when making a decision regarding operative treatments in adult patients with acetabular dysplasia.

Significantly Poor Outcomes of Total Hip Arthroplasty After Failed Periacetabular Osteotomy

BackgroundPeriacetabular osteotomy (PAO) is an effective treatment for preosteoarthritis and early osteoarthritis in young and active patients with hip dysplasia. However, conversion to total hip arthroplasty (THA) for failed PAO is difficult owing to morphologic changes. The objective of the present study was to investigate outcomes of patients who underwent THA for failed PAO. MethodsWe performed a case–control study. The participants were 48 patients (52 hips) who underwent THA after PAO (the osteotomy group); type of PAO was eccentric rotational acetabular osteotomy in 36 hips and rotational acetabular osteotomy in 16 hips. These patients had a mean age at surgery of 56.5 years and underwent postoperative follow-up for a mean period of 5.4 years. For the control group, after matching age, gender, and time of surgery, we included 96 patients (104 joints) who underwent primary THA for hip dysplasia. ResultsThe 2 groups demonstrated no significant difference in the preoperative Harris Hip Score. However, the osteotomy group demonstrated a significantly poor Harris Hip Score at the last follow-up, with particularly low scores for gait and activity. The osteotomy group demonstrated significantly poor range of motion at the last follow-up. Although neither group had any cases of revision surgery, both groups had 1 case of postoperative dislocation. Considering socket placement in Lewinnek’s safe zone, the osteotomy group had significantly poorer results compared to that obtained after primary THA. ConclusionThe therapeutic outcomes and socket positioning for THA after PAO were poorer compared to those of primary THA.

Surgical Education of Eccentric Rotational Acetabular Osteotomy for HIP Trainees

Periacetabular osteotomy is an excellent intervention for patients at early-stage osteoarthritis, but surgical education for this technique is more difficult than that for total hip arthroplasty. 47 joints were included from patients who underwent eccentric rotational acetabular osteotomy (ERAO) performed by 6 trainees under the instructing physician's guidance. We evaluated operative time, blood loss, radiographic parameters, clinical scores, perioperative complications, and 10-year survival rates. We also compared trainees' cases with 47 joints from patients in a sex- and age-matched control group that underwent ERAO performed by the instructing physician. Hip surgery trainees took an average of 152 minutes and the instructor took 103 minutes. Blood loss during surgery by the trainees and the instructor was 382 and 276 g, respectively. Postoperatively, for the trainee and instructor groups, respectively, the Harris Hip Score improved to 88.9 and 93.7 points; the average centre-edge angle improved to 34.0°and 36.1°; and the average acetabular head index was 93.9% and 95.7%. Perioperative and postoperative complications were observed in 14 patients of the trainee group and 3 patients of the instructor group, which were significantly different (p = 0.0061). The 10-year survival rates were 97.8% and 100% for the trainee and instructor groups, respectively. Postoperative imaging evaluations showed no evident differences in coverage. Postoperative clinical outcomes were also satisfactory. Thus, under proper guidance, education to hip surgery trainees on operative techniques is possible. Instructors need to make more effort to prevent complications by providing good education.

Application of 3D reconstruction navigation template in Bernese periacetabular osteotomy

Objective To explore the feasibility of using a navigation template designed based on CT 3D reconstruction in Bernese periacetabular osteotomy (PAO). Methods The 3D print navigation template technology was introduced in the Bernese periacetabular osteotomy for 26 patients (26 hips) with acetabular dysplasia from July 2013 to March 2015. They were 10 males and 16 females, 12 to 32 years of age (average, 18.6 years). There were 14 right hips and 12 left ones. Preoperative patients were prepared by pelvic plain film, CT scan, CT data reconstruction and simulated acetabular osteotomy and rotation in Mimics10.1 software. According to preoperative planning, reverse engineering technology was applied to extract the pelvic anatomic morphology and the osteotomy surface of operative field. Navigation templates were designed and manufactured by 3D printing technology. In operation, the navigation template was attached onto the exposed pelvis and osteotomy surface with complete accurate rotation displacement of osteotomy and acetabular bone block. Lateral center-edge (LCE) angle, acetabular index (AC), extrusion index (EI) and femoral coverage were analyzed. Results The operation time for this group ranged from 2.7 to 4.6 hours, averaging 3.2 hours. Intraoperative bleeding ranged from 950 mL to 3,300 mL, averaging 1,630 mL. No injury to the femoral nerve or sciatic nerve was observed in this group. No serious complications like bone fragments into the hip joint occurred. Postoperative infection was not found in all the cases. Posterior column breakage occurred in only one case. There were significant differences between the preoperative and postoperative measurements regarding LCE, AC, EI and femoral coverage (P 0.05). Conclusion Since application of the navigation template designed based on CT 3D reconstruction in PAO can improve the surgical accuracy and safety, it is an effective method to solve the difficulties of PAO. Key words: Hip dysplasia; Osteotomy; Computer-aided design; 3D reconstruction; Navigation template

Hip Dysplasia in the Young Adult.

Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip. An increase in mechanical stress on the cartilage matrix with failure of the acetabular labrum represents the major pathomechanism of degeneration. Because the prevalence of associated femoral deformities is high (>50%), the structural anatomy of the dysplastic hip must be assessed in multiple planes using radiographs and, if needed, advanced imaging modalities. Acetabular osteotomy (periacetabular and/or rotational) is the most commonly used procedure for the treatment of the majority of dysplastic hips in adults. Modern total hip replacement remains an excellent option for the more arthritic joints. Difficulties can arise from anatomical abnormalities and previous operations.

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia.

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.

Safety and Accuracy of Ct-Based Navigation for Rotational Acetabular Osteotomy

Background: Although there are several clinical reports of the accuracy and safety of navigation for total hip arthroplasty, there have been few clinical reports on navigation for rotational acetabular osteotomy (RAO). The purpose of this study was to evaluate clinically the safety and accuracy of CT-based navigation for RAO. Method: We retrospectively reviewed consecutive 36 hips of 29 cases with symptomatic hip dysplasia who underwent RAO using the CTbased navigation between July 1999 and September 2009. Results: All patients were female. The average age at operation was 31years with a range of 17 to 48 years. Radiographic measurements showed the level of the osteotomy from the articular surface ranged from 15 mm to 20 mm with an average of 16 mm ± 1.3 mm (SD). No fragmentation or crack of the acetabulum due to intra-articular osteotome perforation was identified. The average center-edge angle improved significantly from 1° on preoperative radiographs to 34° on the immediate postoperative radiographs (p ＜ 0.001). All patients were followed-up for a minimum of five years with an average follow-up term of eight years (range, 5 to 15 years). There were no complications such as infection, nonunion, avascular necrosis or neuro-vascular injuries. The Merle d’Aubigne and Postel hip score improved from 13.7 preoperatively to 16.9 at the latest follow-up. Radiographically, progression of the joint space narrowing was found in one hip. The remaining cases showed no progression of osteoarthritis. No hip was converted to total hip arthroplasty. Conclusion: CT-based navigation for RAO is safe and accurate with substantial clinical improvement in patients with hip dysplasia.

Surgical Techniques of Eccentric Rotational Acetabular Osteotomy.

This report describes the operative indications and essential techniques of eccentric rotational acetabular osteotomy for hip dysplasia in patients with either pre-osteoarthritis, early arthritis, or in some cases even advanced osteoarthritis of the hip. An accurate lateral decubitus position of the pelvis is important. Make a bikini skin incision and elevate the skin flap. Make a Y-shaped incision, retract the innominate fossa, and detach the greater trochanter with an oscillating saw. Partially release and divide the rectus femoris, detach the iliacus, and retract the iliopsoas. It is essential to use an osteotomy guide to perform an accurate spherical osteotomy. The osteotomy of the pubic bone is technically demanding. The acetabular fragment can be rotated to the intended position as determined by the preoperative planning. Fix the greater trochanter with two AO cancellous screws. Walking with a walker and partial weight-bearing begins one day after surgery, and full weight-bearing starts at two months postoperatively. The clinical and radiographic outcomes in the first 126 consecutive patients (132 hips) who had undergone eccentric rotational acetabular osteotomy at our institution were retrospectively assessed.IndicationsContraindicationsPitfalls & Challenges.

Hip range-of-motion (ROM) is less than normal after rotational acetabular osteotomy for developmental dysplasia of the hip: A simulated ROM analysis.

The optimal reorientation of the acetabulum for developmental dysplasia of the hip (DDH) is unknown in terms of hip range-of-motion (ROM). The simulated ROMs of 52 DDHs after rotational acetabular osteotomy (RAO) with several patterns of femoral head coverage and those of 73 normal hips were analyzed using computer models reconstructed from CT images. After RAO with a lateral center edge angle (LCEA) of 30° and an anterior center edge angle (ACEA) of 55° producing coverage similar to that of normal hips, the maximal flexion and maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. To achieve ROMs after RAO similar to those of the normal group, an LCEA of 30° with an ACEA of 45°, an LCEA of 25° with an ACEA of 45° to 50°, and an LCEA of 20° with an ACEA of 50° could be preferred angles to target, even though they provided smaller coverage than that of normal hips. After RAO producing femoral head coverage similar to that of normal hips, the maximal flexion and the maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group.

The effect of acetabular and femoral component version on dislocation in primary total hip arthroplasty.

The purpose of the present study was to: (1) investigate the variation of both acetabular and femoral component version in a large series of consecutive primary THA patients, and (2) to better define the associations of acetabular and femoral component alignment and clinical factors with subsequent hip dislocation in those patients. We analyzed CT scans of 1,555 consecutive primary THAs and measured version of the components. We also documented the frequency and direction of subsequent dislocation as well as femoral head size, posterior tissue repair, any history of previous hip surgery, and gender. The dislocation rate after THA was 3.22 %. The dislocation risk was 1.9 times higher if cup anteversion was not between 10° and 30°. Compared to hips that did not dislocate, those that experienced anterior dislocation had a significantly greater combined anteversion; those that dislocated posteriorly had a significantly smaller combined anteversion. Hips with previous rotational acetabular osteotomy or head size smaller than 28 mm correlated with an increased dislocation rate. The dislocation risk could be higher if cup anteversion was not between 10° and 30°. Greater combined anteversion could be a risk factor of anterior dislocation, and posterior dislocation could be more common in smaller combined anteversion.

Total Hip Arthroplasty after Previous Acetabular Osteotomy: Comparison of Three Types of Acetabular Osteotomy

To compare surgical results of total hip arthroplasty (THA) following acetabular osteotomy, operative records of 13 hips following Chiari osteotomy (Chiari group), 22 hips following rotational periacetabular osteotomy (RAO; RAO group), 16 hips following shelf acetabuloplasty (Shelf group), and 2475 hips without previous osteotomy (Control group) were retrospectively reviewed. The operative time was significantly longer in the RAO group than in the Control group. Bulk bone augmentation was required more often in the Chiari and RAO groups than in the Control group. An early migration of the acetabular cup occurred in 2 hips in the RAO group. RAO made conversion to THA more complicated than did the Chiari osteotomy or the shelf acetabuloplasty.

Total hip arthroplasty after previous rotational acetabular osteotomy.

Rotational acetabular osteotomy (RAO) is a joint-conserving surgery in which femoral head coverage is improved using autologous cartilage to stabilize the joint. For advanced coxarthrosis, it has been reported that radical surgery should be selected, compared to the pre- and early stages. The objective of this study was to determine the clinical outcomes of patients in whom coxarthrosis progressed after RAO and came to undergo total hip arthroplasty (THA). We compared 24 total hip arthroplasties done in dysplastic hips after previous rotational acetabular osteotomy (RAO group) with a well-matched control group of 24 primary arthroplasties (control group) done during the same period at an average follow-up of 85months (range 15-195). RAO group required significantly longer operative times and had more intraoperative blood loss. There was no significant difference between the two groups in terms of Harris Hip Score and radiographic outcome. Revision was performed in four and one joints in the RAO and control groups, respectively, showing no significant difference between the two groups (p=0.165). THA after previous RAO leads to midterm results similar to those of other dysplastic hips. RAO does not seem to compromise the midterm clinical and radiographic outcome.