Shelf Operation Research Articles

Hybrid acetabuloplasty of Chiari pelvic osteotomy and shelf operation

Hybrid acetabuloplasty of Chiari pelvic osteotomy and shelf operation

Relief from pain after Bombelli’s valgus-extension osteotomy, and effectiveness of the combined shelf operation

Between 1979 and 1993, we treated 67 hips in 58 patients with severe osteoarthritis caused by congenital dislocation of the hip, employing Bombelli’s valgus-extension osteotomy. The mean age of the patients was 43.6 years (range, 23–59 years). The mean follow-up period was 9.7 years (range, 5–16 years). Thirty-three of the 67 joints were followed-up for more than 10 years after the operation. Of the 67 joints, 31 were operated on by Bombelli’s valgus-extension osteotomy combined with a shelf operation (combined group), and 36 by Bombelli’s valgus-extension osteotomy alone (single group). Clinical evaluation was made according to the Japanese Orthopaedic Association (JOA) hip score system (JOA hip score). In order to assess the effectiveness of this operation in regard to sustained relief from pain after the operation, Kaplan-Meier survivor analysis was performed on the basis of pain score on the JOA hip score. The end-point of the Kaplan-Meier analysis was defined as a score of less than 20 points on the pain score at the time of follow-up or conversion to total hip arthroplasty. In order to analyze the factors that exacerbated pain and to assess the effectiveness of the combined shelf operation, the degree of superior displacement of the femoral head (measured from roentgenograms) after the operation was examined in relation to the pain score. The mean JOA hip score improved, from 56.1 ± 11.0 before the operation to 77.0 ± 16.1 at the latest follow-up. Kaplan-Meier analysis showed a survival rate of 79.4% 10 years after the operation. Superior displacement of the femoral head had gradually progressed with time after the operation in patients with and without the combined shelf operation. Displacement of the femoral head was positively correlated with the acetabular angle of the weight-bearing surface (WBS angle) (sourcil) preoperation. The mean pain score in the combined group was significantly higher than that in the single group 6 to 9 years after the operation. The results of our assessments led us to conclude that Bombelli’s valgus-extention osteotomy is satisfactory as far as clinical and radiological evaluations are concerned, as relief from the pain has continued for more than 10 years after the operation. The combined shelf operation is effective for relieving pain in severe osteoarthritis caused by congenital dislocation of the hip.

A new shelf operation for rheumatoid wrists

A new shelf operation for rheumatoid wrists

変形性股関節症に対する臼蓋棚形成術の術後成績

Surgical treatment of secondary osteoarthritis is controversial. We evaluated clinical results of the shelf operation and discussed the indications. Clinical examination was carried out on twentyone hips in nineteen patients. Fifteen patients had only shelf operations and six had combined interochanteric osteotomies. The average follow-up was eight years four months. The mean center edge angle improved from 7.0°to 39.5°. The mean acetabular head index improved from 56.5% to 90.5%. The preoperative mean Japanease Orthopedic Association (JOA) hip score was 65.2 and postoperatively this increased to 85.5. Only one patient had total hip arthroplasty at last follow-up. We believe the shelf operation may be taken into consideration for treatment of secondary osteoarthritis.

先天性多発性関節拘縮症の股関節脱臼について

Congenital dislocation of the hip with arthrogryposis multiplex congenita is more difficult to treat than developmental dislocation of the hip by either nonsurgical or surgical means. We treated 5 patients (7hips) surgically from 1980 to 1995. The average age at the time of surgery was approximately 2 years, except for 1 patient who was operated on when aged 7 years. Four patients (6hips) were treated by open reduction (O. R.), derotation-varus osteotomy (D. V. O), and shelf operation or pelvic osteotomy. One patient (1hip) was treated by O. R. and D. V. O. Reduction was relatively successful in all patients, with no recurrence of dislocation. Range of motion of the hip could be maintained by aggressive and continuous motion exercise which was commenced 4 weeks after surgery with the removal of the hip spica cast.

Augumentation Shelf Operation of Acetabulum for Hip Dysplasia

Augumentation Shelf Operation of Acetabulum for Hip Dysplasia

変形性股関節症に対する大腿骨わん曲内反骨切り術の成績 臼蓋形成術併用例の検討

変形性股関節症に対する大腿骨わん曲内反骨切り術の成績 臼蓋形成術併用例の検討

膝痛の原因と考えられた榊原分類Ｄ型タナ症例の検討

Though it is easy to resect the medial shelf, it is dificult to make a correct diagnosis for the shelf disorder.Arthroscopic shelf resection for the D type medial shelf was performed on 13 knees of 13 patients.Based on these arthroscopic and clinical findings, the cause of poor results after shelf operation was discussed.Our conclusions are:1. It is very difficult to make a clinical diagnosis before operation.2. Its seems that misdiagnosis is often the cause of poor results.

股関節症に対する外反骨切り術の成績

Forty-seven patients (50 hips) with osteoarthrosis were treated with valgus osteotomy. The mean follow-up period was 4 years and 10 months. According to the JOA score, the preoperative scores (mean, 53.3 points) improved postoperatively (mean, 84 points). For the best result it is necessary that the incongruity be improved by a valgus osteotomy and the weight-bearing area be enlarged by a shelf operation.

The Spitzy shelf operation for the dysplastic hip. Retrospective 10 (5-25) year study of 124 cases.

Since 1961 we have used the Spitzy shelf operation combined with a vertical flap osteotomy of the outer cortex of the ilium for early arthrosis secondary to acetabular dysplasia, subluxation, and dislocation. In 124 hips, followed for 10 (5-25) years, clinical improvement was maintained in 67/85 of patients who were operated on under the age of 30 and in 22/39 of patients treated after 30. However, less than half of the hips in the younger group and only one out of ten in the older group were symptom-free.

股関節症に対する臼蓋形成術の検討

Thirty-seven patients (39 hips) with advanced osteoarthritis of the hip were treated by a shelf operation combined with valgus osteotomy. Their clinical and radiological results were evaluated by the JOA-score and acetabular head index (AHI). The average age at operation was forty-five years and six months old (range, 28 to 58 years). The mean follow-up period was two years and nine months (range, 1 to 5 years).The clinical result was good or excellent in seventeen hips (43.6%). The good and excellent group (over 80 points) in our clinical study was 84.6% for the AHI, while in the poor group (under 70 points) was 72.0%. It is apparent that a minimum of 85% coverage using the AHI is necessary for the best result.

Shelf Operation with Bone and Bone Cement

Shelf Operation with Bone and Bone Cement

A long-term review of shelf arthroplasty.

Shelf arthroplasty is briefly reviewed in historical perspective and the results in 45 hips (39 patients) which had undergone this procedure at the Royal Children's Hospital are presented. The majority of these patients were adolescents who had previously been treated for congenital dislocation or subluxation of the hip. The indications for operation and the operative technique are discussed. Clinical examination was carried out upon 33 of the 39 patients at an average of 11 years after operation. The results suggested that where pain had been an indication for operation almost 80 percent of the hips remained relatively free of symptoms at the time of follow-up and in those patients where acetabular dysplasia had been an indication, the coverage remained good and pain had not appeared. It is concluded that the shelf operation is useful for dealing with both pain and dysplasia in the adolescent.

The shelf operation for hip dysplasia in adolescence

Failure of normal acetabular development is inevitable in congenital dislocation of the hip when it is unrecognised until late infancy or early childhood. Numerous stabilising procedures have been described, one of the first being the shelf operation or acetabuloplasty. This procedure fell into disrepute because the shelf was often located too high or was too small to prevent upward migration of the femoral head. The technique described emphasises the importance of resecting the thickened capsule and exposing the lateral margin of the acetabulum to allow a substantial portion of the outer cortex of the ilium to be turned down both laterally and anteriorly over the femoral head. Twenty cases of acetabuloplasty have been followed up for an average period of nine years. The results have been assessed from the point of view of function, relief of pain, and degree of support of the femoral head as demonstrated radiologically. The shelf operation is a simple and safe procedure, and provided it gives adequate support to the subluxated femoral head it will ensure a stable, mobile joint capable of standing up to reasonable use for many years. If deterioration should occur in later life, total hip replacement may be undertaken more easily than if the joint had been allowed to undergo progressive subluxation.

Shelf operation for congenital subluxation and dislocation of the hips : W. H. Bickel and J. S. Breivis. Clin. Orthop. 106:27–34 (January–February), 1975

Shelf operation for congenital subluxation and dislocation of the hips : W. H. Bickel and J. S. Breivis. Clin. Orthop. 106:27–34 (January–February), 1975

Shelf operation for congenital subluxation and dislocation of the hip.

One hundred forty-one shelf procedures were performed on 120 patients who had congenital hip dysplasia or dislocation. Long-term follow-up evaluation of hip function revealed that about three-fourths of the patients had satisfactory results. Although some children less than 10 years old may have benefited, this age group has the highest percentage of failures of shelf operation. The shelf procedure provides a buttress of bone for later reconstructive surgery such as cup or total hip arthroplasty.

On the Indication of Shelf Operation and Chiari' Pelvic Osteotomy

On the Indication of Shelf Operation and Chiari' Pelvic Osteotomy

Studies of Shelf Operation

The results of 50 shelf operations to 45 patients were followed up. The average of their age was 10 years and 1 month, and the average period of observation was 6 years and 4 months.The method of shelf operation was mostly followed after Jinnaka's method.Functional capacity of the hips and X-ray findings were evaluated in each case. The majority of the cases showed good functional hips without limb or pain in walking. Younger the age at surgery revealed better results. the oldest case who was 48 years old at the time of surgery showed poor functional result.Improvement of CE angle and Acetabular angle were detected, however as far as concerning X-ray findings, generally the result of surgery was poor.As a whole, 80% of the cases showed functional improvement more or less, and 6% showed bad result.

Observations on Late Results of Operative Treatment for Osteoarthritis of the Hip

The results of operative treatment for osteoarthritis of the hip were evaluated on 62 hips in 53 cases (10 males and 43 females), 11 cases being primary and 42 secondary in nature. The operative methods employed were displacement osteotomy in 26 cases, displacement-varus osteotomy in 15, displacement-valgus osteotomy in 8, shelf operation in 7, arthrodesis in 4 and prosthesis operation in one, and the follow-up period was on an average of 3 years and 2 months.Thirty eight out of 44 unilateral cases satisfied with the operation, and in the majority of them the clinical results coincidented with the final X-ray findings, especially, 95% of 20 cases showed excellent improvement of the X-ray findings satisfied with the operation.Five cases out of 9 bilateral cases, of which 4 cases showed the excellent improvement of X-ray findings, satisfied with the operation.

Open Reduction in Congenital Dislocation of the Hip

In congenital dislocation of the hip, twenty hips were followed up for two years or more after open reduction. Among them, only seven hips (35%) had satisfactory results radiologically and functionally. In this experience, it was found that the factors influencing the result were age at surgery, surgical technique, surgical trauma to the greater trochanter, and adaptation of hip. Especially, postoperative contructure of the hip and osteochondritis were seemed important factors.In conclusion, early complete reduction and good movement were necessary to obtain good result. For these purposes, not only so called open reduction involving excision of limbus, teres ligament, and fibro-fatty tissue in the joint, but also varus-derotation osteotomy, pelvic osteotomy, or shelf operation may be add if necessary.