{"title":"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","authors":"Hiroaki Kurishima , Daisuke Chiba , Kazuyoshi Baba , Soshi Hamada , Takayuki Suzuki , Ryuichi Kanabuchi , Genji Fujii , Masamizu Oyama , Tatsuhiro Ochiai , Yu Mori , Toshimi Aizawa","doi":"10.1016/j.jos.2023.05.013","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Clinical outcomes of Chiari pelvic osteotomy<span> for acetabular<span> dysplasia<span><span>, including conversion to total hip arthroplasty<span> (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 </span></span>prognostic factors as the second outcome.</span></span></span></p></div><div><h3>Methods</h3><p>This 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.</p></div><div><h3>Results</h3><p>The 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).</p></div><div><h3>Conclusion</h3><p>Chiari 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.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Science","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0949265823001410","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Clinical 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.
Methods
This 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.
Results
The 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).
Conclusion
Chiari 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.
背景:目前尚未充分探讨Chiari骨盆截骨术治疗髋臼发育不良的临床效果,包括转为全髋关节置换术(THA)的效果。本研究的目的是以Chiari骨盆截骨术的长期结果和临床疗效为首要结果,分析其预后因素为次要结果:本研究是一项多中心、回顾性队列研究。方法:本研究是一项多中心回顾性队列研究。1975年3月至1997年10月期间,97名患者在三家医院接受了Chiari骨盆截骨术。研究采用Kaplan-Meier法分析了Chiari骨盆截骨术的长期临床结果,包括转为THA和髋关节疼痛。此外,还通过临床变量和放射学参数评估了基底骨盆截骨术后转为全髋关节置换术的预后因素:该研究纳入了45名患者(4男41女)的51个髋关节,并进行了长期随访。以转为全髋关节置换术为终点,Kaplan-Meier分析评估的生存率为:20年为90.2%(95%置信区间(CI)82.0-98.4%),30年为73.5%(95%置信区间(CI)61.1-86.0%)。相比之下,以日本骨科协会髋关节疼痛评分≤20分为终点,20岁时的卡普兰-米尔生存率为86.3%(95% CI 76.8-95.7%),30岁时为65.6%(95% CI 52.3-79.0%)。只有截骨时的年龄较大才是转为 THA 的显著不良预后因素,其危险比为 1.11/年(95% CI 1.06 至 1.18)(P 结论:Chiari 骨盆截骨术是一种非常有效的治疗方法:Chiari骨盆截骨术可能仍然是髋臼发育不良骨性重建手术的良好替代方案,尤其是对于年轻患者。只有截骨时年龄较大的患者在保留髋关节功能方面预后较差。
期刊介绍:
The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.