重度変形性股関節症に対する寛骨臼回転骨切り術

抄録

Objective: We reconsidered the indication for Rotational Acetabular Osteotomy (RAO) for advanced coxarthrosis near terminal stage the (“a⁺”group), and at the“terminal stage”, in consideration of long term results, because postoperative results in these groups were inferior to those in cases of precoxarthrosis and early stages.
Methods: The subjects of this study were 34 joints in the“a⁺” (advanced) group, and 25 joints in the“terminal stage”group, which we could follow over ten years. We divided the“a⁺”group into “good”“fair”and“poor”groups by joint congruity in abducted-position X-ray pictures. We considered these cases by JOA score, joint congruity and survival rate. Regarding survival rate we defined any JOA score less than 70 points as end-point.
Results: There were 8 joints in the “good”group, 17 joints in the“fair”group, 9 joints in the “poor”group, and 25 joints in the“terminal stage”group. The average age at operation was 36.8 (19-52), and the average period of follow-up was 158.4 months (120-241) . JOA scores at the last follow-up time were higher than before operation in all groups, but the scores in the“fair”, “poor”, and“terminal stage” groups were much lower than in the“good” group. The survival rate in the“good” group was also comparatively good (75.0%), but in the“fair”, “poor”, and“terminal stage” groups they were much lower than in the“good” group.
Conclusion: Results in the“good” group were comparatively good, so we consider that RAO may be indicated for this group. Long term results in the“fair”, “poor”, and“terminal stage” groups were lower. We consider that RAO would not be indicated for cases in which any combined operations did not work to give good joint congruity. On the other hand, there are cases which have maintained good results over ten years ; we consider that these may indicate a role as a“time-saving” procedure before total hip arthroplasty.