Original Article
Joint space wider than 2 mm is essential for an eccentric rotational acetabular osteotomy for adult hip dysplasia

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Abstract

Background

Satisfactory intermediate-term results after an eccentric rotational acetabular osteotomy (ERAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip (DDH) have been reported. The purpose of this study was to investigate whether a minimum joint space width (JSW) in patients with advanced osteoarthritis secondary to DDH influences intermediate-term clinical and radiographic outcomes after performing an ERAO.

Methods

A total of 113 patients (116 hips) with a JSW of ≤3 mm were consecutively treated by ERAO for advanced osteoarthritis of the hip and then were followed for more than 5 years. Based on the preoperative JSW, the patients were divided into three groups: minimum JSW of ≤1 mm (JS1 group); JSW >1 mm but ≤2 mm (JS2 group); JSW > 2 mm but ≤3 mm (JS3 group). The average ages of the JS1, JS2, and JS3 patients were 40, 44, and 43 years, respectively. The average follow-up period was 10.6 years.

Results

Overall conversion to total hip arthroplasty (THA) was performed in 14 joints. According to a Kaplan-Meier survivorship analysis at 15 years after the index operation, 96% of the patients with a JSW of >2 mm (JS3 group) did not require conversion to THA.

Conclusions

A JSW of >2 mm before surgery is considered essential to obtain an excellent intermediate-term result following performance of an ERAO.

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      Several previous reports demonstrated that the clinical outcomes of PAO for advanced OA were poor [7,9]. Conversely, our previous report demonstrated that the long-term outcomes of ERAO were preferable if the preoperative joint space was wider than 2.0 mm [16,17]. The present study revealed that the survival rates for patients with preoperative MJS measurements of over 2.0 mm—using an HHS of <80 as the end point—were similar following ERAO, regardless of whether the procedure was performed with or without ITVO.

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      On preoperative radiographs, joint space ranged from 0 to 4 mm. In fact, in particular in patients with DDH, with previous acetabular osteotomy, is essential a minimum joints space to obtain excellent clinical and radiographic results; excellent congruity is an important predictor for a stable and well-positioned implant [19]. All femoral components were well-positioned.

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

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      In the present study, the minimum joint space width and joint abduction ROM were abstracted as predictors of the prognosis. Affected joint conformity and joint space width have been reported as postoperative risk factors [18–21]. Regarding the joint space width, Yasunaga [20] and Hasegawa [21] defined a cutoff value of 2 mm.

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