Silver Anniversary of Hip Osteotomy for Severe ArthritisFor the past 25 years, patients with hip arthritis who are too young for a total hip replacement have had an osteotomy instead. In this joint-saving operation, a wedge-shaped piece of bone is removed from the neck of the femur (the thighbone). A metal plate and screws hold the bone together until it heals.
Taking a piece of bone out changes the way the head of the femur rests inside the hip socket. It gives the joint better contact and improves the joint space. The surgeon may even use the removed bone to make a deeper hip socket. This is done by taking the wedge of bone and attaching it to the outer edge of the hip socket. It forms a little shelf or roof over the bone in the socket.
Long-term results of this operation are unknown. In this study, researchers followed patients for up to 25 years after an osteotomy. They found that although the X-rays looked good, the patient didn't always have a better outcome.
The authors report that patients younger than 50 who have just one hip osteotomy have the best results. Patients over age 50 or who have bilateral osteotomies have a worse result. Pain, range of motion, walking ability, and daily activities were the measures used to rate the outcomes.
Osteotomy is still a good option for severe hip arthritis. Best results occur when the patient is too young for a total hip replacement and only needs an osteotomy on one side. Forming a deeper socket by building a shelf may not be needed.
Kenji Kawate, MD, et al. Twenty-five Years Follow-up of Patients Who Had Valgus Osteotomy for Arthritic Hips. In Clinical Orthopaedics and Related Research. September 2004. Vol. 426. Pp. 151-158.
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