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Joint-Preserving Treatment Can Delay Hip Replacement

81.6 percent of hip joints still surviving at 9.2 years after joint-preserving procedure

FRIDAY, Sept. 4 (HealthDay News) -- Periacetabular osteotomy, or reorienting a shallow hip socket to better engage the head of the femur, can preserve hip-joint function and avoid a full hip replacement for years, according to a study in the Sept. 1 Journal of Bone & Joint Surgery.

Anders Troelsen, M.D., of the University Hospital of Aarhus in Denmark, and colleagues followed-up 116 periacetabular osteotomies performed from December 1998 to December 2002 (mean follow-up, 6.8 years). Clinical and radiographic examinations were conducted, and patients were interviewed and completed pain and functionality questionnaires. A Cox proportional hazards model identified factors predicting a poor outcome for the joint-preserving procedure and eventual full hip replacement.

The researchers found that the hip survival rate after periacetabular osteotomy was 81.6 percent at 9.2 years. On a visual analog scale, patients reported a median pain score of zero at rest and one after walking for 15 minutes. Several preoperative and postoperative factors predicted a poor outcome and eventual hip replacement, including (preoperatively) severe dysplasia, reduced acetabular anteversion angle, and the presence of an os acetabuli, and (postoperatively) small width of the acetabular sclerotic zone and excessive lateral and proximal dislocation.

"Periacetabular osteotomy can be performed with a good outcome at medium-term follow-up, suggesting that it may be applied by experienced surgeons with satisfactory results. To further improve the outcome, focus should be on the potential negative influence of parameters that are easily assessed, such as the preoperative grade of osteoarthritis, the presence of an os acetabuli, and severe acetabular dysplasia," the authors write.

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