Chiari Pelvic Osteotomy Research Articles

Chiari Osteotomy in the Children: Mid-term Follow-Up Results.

Introduction The Chiari osteotomy enlarges the acetabulum to increase coverage of the femoral head. It is performed as a salvage procedure on a noncongruent, yet in-place, hip. This study aims to assess the clinical and radiographic outcomes of Chiari pelvic osteotomy for treating hip dysplasia in children. Methods This is acase series conducted in the pediatric orthopedic trauma department of the Centre Hospitalier Universitaire Hassan II, Fez, Morocco, over a 10-year period from January 2011 to December 2020. The study included patients who were being treated for hip dysplasia and had undergone a Chiari osteotomy. Two types of assessments were used to evaluate global hip function: a clinical assessment using the Merle d'Aubigné and Postel score, and a radiological assessment involving measurements taken from frontal pelvic radiographs. Results A total of 12 Chiari osteotomies were performed in nine patients. The mean age at surgery was 10.8 ± 1.7 years and the mean follow-up was 4.6 ± 2.78 years. The clinical assessment score improved statistically during the last follow-up compared with the preoperative measurements for pain (p<0.001), mobility (p = 0.002), walking (p<0.001), and total score (p< 0.001), for which 3.8 ± 1.9 points could be gained. Surgically, the osteotomy line height was 5.4 ± 2.6 mm, the osteotomy angle was 12.5 ± 2.2°, and the translated distance was 18.5 ± 3.2 mm.Regarding radiological evaluation, the comparison of angle measurements between preoperative and final recoil was statistically significant for both the vertical center edge (VCE) angle (p<0.001) with a mean gain of 16.33 ± 4.79° and the high transverse edge (HTE) angle (p = 0.002) with a mean loss of 12.67 ± 10.88°. Conclusion Chiari pelvic osteotomy is a complex procedure that requires very precise techniques. However, it results in remarkable relief for patients, providing an immediate impact on the Merle d'Aubigné and Postel score, particularly with regard to pain.

Finite Element Analysis of Various Osteotomies Used in the Treatment of Developmental Hip Dysplasia in Children.

Late-discovered developmental hip dysplasia deformities often necessitate complex surgical treatments and meticulous preoperative planning. The selection of osteotomies is contingent upon the patient's age and the specific structural deformity of the hip. In our anatomical hip model, derived from the data of a 12-year-old patient, we performed virtual osteotomies that are commonly recommended for such cases. We precisely constructed geometric models for various osteotomies, including the Dega, Pemberton, Tönnis, Ganz, Chiari pelvic, and Pauwels femoral osteotomies. We employed Autodesk Inventor for the finite element analysis of the hip joint and the corrective osteotomies. In comparing one-stage osteotomies, we noted that the Dega and Ganz pelvic osteotomies, especially when combined with the Pauwels femoral osteotomy, yielded the most favorable outcomes. These combinations led to enhanced femoral head coverage and reduced intra-articular pressure. Furthermore, we calculated the femoral head-to-acetabulum volume ratio for both the Dega and Pauwels osteotomies. The encouraging results we obtained advocate for the integration of finite element analysis in virtual osteotomies of the pelvis and femur as a preoperative tool in the management of developmental hip dysplasia.

Long-Term Results after Chiari Pelvic Osteotomy in the Skeletally Immature and the Role of the Anti-Chiari Effect.

Several authors observed a loss of correction after performing Chiari pelvic osteotomy (CPO) in young patients. Hence, the aim of this study was to answer two questions: (1) Does the Chiari pelvic osteotomy affect the development of the acetabulum in skeletally immature patients in the long term? (2) Is there any evidence of the previously described "Anti-Chiari" effect after a mean follow-up of 36 years? Data from 21 patients (27 hips) undergoing CPO before the age of 16 years were clinically assessed, and the evolution of radiological parameters over time was analyzed. The mean age at CPO was 11.2 years (±3; 4.4-15.7). The 20- and 30-year survival rates of the CPO were 100% and 92.6%, respectively. Mean postoperative medialization was 54% (±18; 23-99). The average osteotomy angle was 11° (±7; 2-28). No significant changes were found for the center-edge angle (CEA) and acetabular index (AI) over time; the angle of Idelberger and Frank (ACM) almost reached normal values at follow-up (FU); for the acetabular-head index (AHI), a slight shift toward the initial situation could be detected. The morphology of the acetabulum remained unchanged over time. The "Anti-Chiari effect" seems to be primarily caused by insufficient coverage of the femoral head rather than damage to the apophysis due to surgery.

Ultra-long-term results of the Chiari pelvic osteotomy in hip dysplasia patients: a minimum of thirty-five years follow-up

PurposeThe Chiari pelvic osteotomy was the first surgical procedure to address hip dysplasia by changing the position of the acetabulum by medialization, thus creating a bony roof and improving biomechanical conditions. The aim of this retrospective cohort study was to report on the very long-term results of this technique.MethodsOut of a consecutive series of 1536 hips, 504 in 405 patients were available for follow-up. The patients were assessed by physical and radiological examination. A Kaplan–Meier survival analysis with total hip arthroplasty as an endpoint was performed and stratified for age groups, pre-operative diagnosis, sex and osteoarthritis stage.ResultsThe average follow-up was 36 ± 8.1 years (range, 35.2 to 54). The average pain level on the Visual Analogue Scale was 2.9 ± 2.6 (range 0 to 8.7). The average Harris Hip Score was 80.2 ± 17.4 (range 17.4 to 100). Correction of dysplasia was effective and remained stable over time. Osteoarthritis significantly increased over time with 53% Tönnis grade 3 at follow-up. The cumulative survivorship was 79.8% (95% confidence interval (CI), 76.1–83.2%) at 20 years, 57.1% (95% CI, 52.8–61.8%) at 30 years and 35% (95% CI, 30.3–40.3%) at 40 years. Young age, male sex and low osteoarthritis grade were positive prognostic factors.ConclusionsAlthough the Chiari pelvic osteotomy is considered a salvage procedure nowadays, it achieved excellent long-term results even in indications, which would be treated differently today. Young patients without osteoarthritis had the best outcome.

Long-term results of Chiari pelvic osteotomy on the preservation of hip function with mean follow-up of more than 30 years and its prognostic factors

BackgroundClinical outcomes of Chiari pelvic osteotomy for acetabular dysplasia, including conversion to total hip arthroplasty (THA), have not been adequately explored. The purpose of this study was to examine the long-term results and clinical outcomes of Chiari pelvic osteotomy as the primary outcome and to analyze its prognostic factors as the second outcome. MethodsThis study was a multicenter, retrospective cohort study. Ninety-seven patients underwent Chiari pelvic osteotomy at three hospitals between March 1975 and October 1997. The long-term clinical outcomes of Chiari pelvic osteotomy, including conversion to THA and hip pain, were analyzed using the Kaplan–Meier method. In addition, the prognostic factors for conversion to THA after Chiari pelvic osteotomy were evaluated with clinical variables and radiographic parameters. ResultsThe study included 51 hips in 45 patients (4 men and 41 women) with long-term follow-up. The survival rates assessed by Kaplan–Meier analysis with conversion to THA as an endpoint, were 90.2% (95% confidence interval (CI) 82.0–98.4%) at 20 years and 73.5% (95% CI 61.1–86.0%) at 30 years. In contrast, the Kaplan–Meier survival rates with the Japanese Orthopaedic Association hip score for pain ≤20 as an endpoint, were 86.3% (95% CI 76.8–95.7%) at 20 years and 65.6% (95% CI 52.3–79.0%) at 30 years. Only older age at osteotomy was the significantly poor prognostic factor for conversion to THA, with a hazard ratio of 1.11/year, 95% CI 1.06 to 1.18, (p < 0.01). ConclusionChiari pelvic osteotomy may still be a good alternative to bony reconstructive surgery for acetabular dysplasia especially in young patients. Only older age at the osteotomy was related to the poor prognosis of preserving hip function.

Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up.

The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6-21.3) years. Mean age at surgery was 10.2 (range 8.2-17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65-100) points. An excellent functional outcome (HHS 90-100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.

Total Hip Arthroplasty after Previous Chiari Pelvic Osteotomy—A Retrospective Study of 301 Dysplastic Hips

BackgroundControversy exists whether previous pelvic osteotomies have negative effects on total hip arthroplasty (THA). This study evaluates the implant survival and patient-reported outcomes of THA after previous Chiari pelvic osteotomy (CPO). MethodsData on 301 THAs after CPO were collected through clinical and radiological follow-up examinations and telephone interviews. The Kaplan-Meier survivorship analysis depicts implant survival. ResultsOf 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). At follow-up, 301 hips (60%) had already undergone THA. The overall survival of THA with revision as an end point after 10, 20, and 25 years was 93%, 76%, and 68%, respectively. The revision rate was 12%. The average period between THA and revision surgery was 9.6 years (±6.1; 4 months-25.4 years). The patient’s age at revision was 57.9 years (±10; 33.2-78.5 years). Aseptic loosening was the most common of the known reasons for revision surgery. ConclusionThis retrospective study supports the hypothesis that prior CPO does not compromise the prerequisites for successful THA at a later stage. Survival rates of the implanted prosthesis are comparable to primary implanted hips, as overall survival was 93% after 10 years.

Chiari pelvic osteotomy does affect hip survival: a long-term follow-up study.

The modern indications for Chiari pelvic osteotomy (CPO) have narrowed and the number of such operations performed has diminished markedly. So far published long-term experience with CPO indicate the fact that in selected patients satisfactory functional results can be achieved. The aim of this study was to investigate the parameters which influence CPO survival and its conversion into total hip arthroplasty (THA). This is a single-centre retrospective case-series study. In the period from 1976 to 2012, it included 172 CPO in 158 patients. Of those, in 43 patients (48 hips) the follow-up was discontinued, leaving 115 patients (124 hips) for final analyses. The median age at the time of the surgery was 34 years, and the mean duration of the follow-up was 19 years. In 115 patients (124 CPO) included in the study, a total of 51 THA was performed in 49 patients. The median period between CPO and THA was 14 years. Supporting our results, we suggest that CPO should still be indicated in a selected group of younger patients even with advanced stage of hip osteoarthritis who prefer a joint-conserving procedure and consent to a predicted less optimal outcome.

Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip.

Background:Surgeons have long debated whether advanced or end-stage osteoarthritis of the hip in young patients should be treated with total hip arthroplasty or osteotomy. We reviewed the intermediate-term clinical results of valgus femoral osteotomy combined with Chiari pelvic osteotomy (VCO) for advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip in young patients and analyzed prognostic factors related to conversion to total hip arthroplasty.Methods:The study group included 54 hips in 50 patients (5 men and 45 women; average age at the time of surgery, 45.6 years). The minimum and average durations of follow-up were 10 and 17.6 years, respectively. The Japanese Orthopaedic Association hip score (JOA score) was used for clinical evaluation. The probability of survival of the VCO from the time of the operation until the end point of conversion to total hip arthroplasty was calculated with use of the Kaplan-Meier method. We defined prognostic factors of outcome (conversion to total hip arthroplasty) with the Cox proportional hazards model.Results:The mean total JOA score increased from 53.0 points preoperatively to 77.1 points at 1 year postoperatively, 81.6 points at 5 years, and 76.8 points at 10 years. The survival rates were 83.3%, 59.7%, and 46.9% at 10, 15, and 20 years, respectively. On univariate and multivariate analyses, patients with a low degree of acetabular roof obliquity had better postoperative results.Conclusions:VCO is a surgical approach that preserves joint function in young patients with advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip. The postoperative prognosis of VCO was improved in patients with a low degree of acetabular roof obliquity.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Robot-assisted Total Hip Arthroplasty after Chiari Pelvic Osteotomy: A Case Report

Congenital hip dysplasia often requires surgical interventions in younger adults. 3D-navigated, robotic-assisted surgery for total hip arthroplasty may be beneficial in cases of pseudo-acetabulum and preceding treatments (Chiari Pelvic osteotomy) due to better pre-surgical planning and higher levels of precision associated with the technology, which may be associated with positive effects regarding short-term and long-term clinical outcomes.Here, we report the case of a 26-year-old Caucasian woman with a Crowe-IV dysplastic hip and pseudo-acetabulum. Earlier interventions included Chiari pelvic osteotomy, femoral osteotomy and femoral lengthening, which did not improve pain and function in the longer term. The surgical approach via robot-assisted surgery lead to positive outcomes in the short-term (four months post-surgery) and medium-term (17 months post-surgery) in this specific case.

2F22 Chiari骨盤骨切り術における臨床成績に与える骨盤傾斜の影響(GS6:動作解析)

2F22 Chiari骨盤骨切り術における臨床成績に与える骨盤傾斜の影響(GS6:動作解析)

New technique to overcome surgical pitfall during Chiari osteotomy

البضع العظمي للحوض بطريقة كياري هو عملية إنقاذية, هدفها الرئيسي تأمين غطاء جانبي لرأس الفخذ عند البالغين المصابين بثدن الحق. ومستوى البضع العظمي مهم جدا ومصيري. حيث يجب أن تقل المسافة بين البضع العظمي وتجويف المفصل عن خمسة ملم وبزاوية مع الاتجاه الرأسي بمقدار عشر درجات باتجاه المفصل العجزي الحرقفي. إن البضع العظمي عالي المستوى سيحدث فجوة غير مرغوب بها بين رأس الفخذ والحق الجديد. نصف هنا طريقة جديدة تهدف إلى التغلب على هذه الفجوة غير المرغوب بها التي حدثت بالبضع العظمي عالي المستوى لفتاة بعمر أربعة عشر عاما لديها بقايا ثدن في الحق بعد أن عولجت جراحيا لإصابتها بخلع تطوري للورك. هذه الطريقة تتضمن نقل الجانب الوحشي للعظم الحرقفي دون الحاجة إلى إزالة البضع العظمي بطريقة كياري وأسفرت الطريقة عن نتائج جيدة في هذه الحالة. Chiari pelvic osteotomy is a salvage procedure, which aims mainly to achieve lateral coverage of femoral head in adolescents with acetabular dysplasia. The level of pelvic osteotomy is very important and crucial. It should be less than five mm from the joint space and directed with a cephalic inclination of 10° toward the sacroiliac joint. High-level osteotomy will create an undesired step between the femoral head and the new acetabulum. A new technique is described here to overcome an undesired step that was created by high level osteotomy in a 14 year old girl with residual acetabular dysplasia after surgically treated developmental dysplasia of the hip. The technique included distal transfer of the lateral part of the iliac bone without the need to dismantle the Chiari osteotomy and resulted in good outcome.

Chiari pelvic osteotomy in treatment of hip dysplasia

Chiari pelvic osteotomy is a surgical procedure having been performed for almost sixty years in patients with the insufficient coverage of the femoral head. It is most frequently used in young patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. Even though performance of the Chiari osteotomy is associated with positive therapeutical results, above all, its main goal is to delay inevitable degenerative changes. Original surgical technique has been modified and improved over time. Nevertheless, the basic idea has remained unchanged--increasing of the femoral head coverage by medial displacement of the distal partof the pelvis along with capsular interpositioning. Given the complexity of operation, the complication percentage is rather low. Chiari pelvic osteotomy has lost its actuality and importance during this past six decades. The role of Chiari pelvic osteotomy has been considerably taken over by other more efficient and more lasting surgical procedures. Nonetheless, Chiari pelvic osteotomy is still present in modern orthopedic practice, above all as,salvage" osteotomy.

Clinical and radiological outcome of combined femoral and Chiari osteotomies for subluxed or dislocated hips secondary to neuromuscular conditions: a minimum of 10-year follow-up

We evaluated the medium-term results of combined Chiari pelvic and femoral osteotomies performed at the Manchester Children's Hospitals between the years 1985 and 1994. The indications for these osteotomies were either hip dislocation or subluxation in children with neuromuscular disease. We clinically and radiologically evaluated 20 hips in 18 patients treated for hip subluxation and dislocation with Chiari osteotomy. The average post-operative clinical follow-up period was 11.32 years (range 10.1-12.9). The mean age at the time of surgery was 7.3 years (range 3.1-13.2 years). Clinically, 9 hips had a 'Good' outcome, 10 were "Fair" and 1 was "Poor" according to Osterkamp criteria. At last follow-up, radiologically the mean Sharp's angle improved from 51° to 44° (p = 0.09), the mean Centre-Edge angle improved from -16° to 18° (p = 0.067), the mean Migration Index improved from 59 to 29 % (p = 0.011), the mean femoral neck-shaft angle from 160° to 117° (p < 0.0001) and the Severin criteria improved from an average grade of 4.5-2.9 (p < 0.0001). Our results compared to previous studies confirm that combined femoral and Chiari osteotomies provide a favourable outcome both clinically and radiologically at least 10 years following surgery. Accepting that the numbers are small, we report no statistical difference in the mean age at the time of operation when comparing the children with an eventual 'good' outcome and those with an eventual 'fair' or 'poor' outcome.

Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography

Currently, the cover of the femoral head was mainly assessed using conventional plain films after Chiari pelvic osteotomy in most studies. The purpose of the current study was to observe whether the femoral head coverage measured by three-dimensional computed tomography (3D-CT) was consistent with the radiographic findings. A total of 24 patients (24 hips) with an average age of 11.5 years, underwent Chiari osteotomy due to acetabular dysplasia, and 15 subjects (30 hips) of normal control with a mean age of 12 years were involved in the study. The pre- and postoperative coverage of femoral head was measured by using conventional plain film and 3D-CT on the anterior 1/4, middle 1/2, and posterior 1/4 coronal plane. The anterolateral, mediolateral and posterolateral coverage measured by 3D-CT were compared with the coverage measured by plain radiograph, and which were also compared with the normal control individuals. The postoperative anterolateral, mediolateral coverage measured by 3D-CT was significantly smaller than that measured by radiography (P < 0.01). No significant difference was found between the 3D-CT measurements on the posterolateral coverage and the radiographic results. The anterolateral femoral head coverage in the patients following Chiari pelvic osteotomy was also smaller than that in the normal control individuals (P = 0.026). In contrast, the postoperative posterolateral coverage in the patients was more excessive than that in the normal control individuals (P = 0.001). Conventional radiographs may show sufficient cover of the femoral head after Chiari osteotomy, whereas in fact, the cover may be not perfect, especially on the anterolateral part. Therefore, the postoperative 3D-CT is beneficial for evaluating the outcome of Chiari osteotomy, especially when the anterolateral coverage o

Relationship between Physical Activity Level and Hip Joint Pain in Adult Women with Chiari Pelvic Osteotomy

Relationship between Physical Activity Level and Hip Joint Pain in Adult Women with Chiari Pelvic Osteotomy

Chiari骨盤骨切り術後患者の身体活動量と健康関連QOLについて

Chiari骨盤骨切り術後患者の身体活動量と健康関連QOLについて

The Chiari pelvic osteotomy for patients with dysplastic hips and poor joint congruency

We report the mid- to long-term (mean 20.3 years, 10 to 32.5) results of the Chiari pelvic osteotomy in patients with pre- to advanced stage osteoarthritis in dysplastic hips. We followed 163 Japanese patients (173 hips) with a mean age at surgery of 20 years (9 to 54). Overall, 124 hips (72%) had satisfactory results, with Harris hip scores ≥ 80. Satisfactory results were seen in 105 of 134 hips with pre- or early osteoarthritis (78%) and 19 of 39 hips with advanced osteoarthritis (49%). A total of 15 hips (9%) underwent a total hip replacement (THR) with a mean interval between osteotomy and THR of 16.4 years. With conversion to THR as the endpoint, the 30-year survival rate was 85.9% (95% confidence interval 82.3 to 89.5). It was 91.8% for patients with pre- or early osteoarthritis and 43.6% for those with advanced osteoarthritis (p < 0.001). We now perform the Chiari osteotomy for patients with dysplastic hips showing poor joint congruency and who prefer a joint-conserving procedure to THR.

Femoroacetabular impingement related to Legg-Calvé-Perthes disease

Femoroacetabular impingement is an undesirable contact between acetabular rim and femoral neck and presents abnormality of proximal femoral part and acetabulum, as well. Two forms may appear: cam impingement and pincer impingement. Femoroacetabular impingement related to Legg-Calvé-Perthes disease may be caused by various reasons, as the consequence of the disease itself, and as the consequence of its treatment. Coxa magna deformity (large femoral head and neck) and coxa brevis deformity (shortened femoral neck) may produce cam femoroacetabular impingement during hip flexion. After the disease, the flattened femoral head (coxa plana) may persist. Chiari pelvic osteotomy is the only treatment option for such femoral head deformity. Acetabular labrum squeezed continuously between the femoral head and the non-articular part of the cut iliac bone lead to cam femoroacetabular impingement, as well. If Salter or triple pelvic osteotomy is used that may cause a very large iatrogenic acetabular retroversion, we can also refer to radial type pincer femoroacetabular impingement. Treatment of Legg-Calvé-Perthes disease should be conducted according to the natural course of the disease and prognosis. Treatment should start on time, well before a crushed femoral head develops, because it is the easiest way to establish hip spherical congruency at the end of treatment. This is the best option to prevent secondary hip arthrosis caused by femoroacetabular impingement or by insufficient head coverage at the end of remodelling. In each case of delayed hip pain, followed by a limited range of movements, femoroacetabular impingement should be taken into consideration, confirmed, and treated by some of the available therapeutic methods.

Postoperative Results of Chiari's Pelvic Osteotomy

Postoperative Results of Chiari's Pelvic Osteotomy