Hip Int 2014; 24 ( 6): 631-637
DOI: 10.5301/hipint.5000158
ORIGINAL ARTICLE
Gender difference does not affect the outcomes of eccentric rotational acetabular osteotomy used in hip dysplasia Takafumi Amano1, Yukiharu Hasegawa2, Taisuke Seki1, Jin Yamaguchi3, Toshiki Iwase4 Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya - Japan Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya - Japan 3 Department of Orthopaedic Surgery, Chubu-Rosai Hospital, Nagoya - Japan 4 Department of Orthopaedic Surgery, Hamamatsu Medical Center, Hamamatsu - Japan 1 2
Introduction: Various types of periacetabular osteotomies have been proposed to treat acetabular dysplasia for young and active patients. Acetabular dysplasia is prevalent in women and rare in men, therefore few reports exist concerning periacetabular osteotomy of male patients. The purpose of this study is to clarify the gender differences in surgical techniques, radiographic and clinical outcomes. Materials and methods: Between 1989 and 2007, we performed 530 eccentric rotational acetabular osteotomies and followed them annually for more than five years. Thirty-six male patients were investigated. As a control group, 72 female patients were matched for age and preoperative stage of osteoarthritis at the time of surgery. We evaluated operative time and blood loss, radiographic parameters, Harris Hip Score (HHS) and survival rate. We investigated the clinical and radiographic differences between men and women. Results: The mean operative time was 148 min in males and 135 min in females. The bleeding during surgery was 445 g in males and 351 g in females. HHS improved 94.1 points in males and 93.5 points in women postoperatively. The mean CE angle improved 31.7° in males and 35.1° in females. The mean AHI was 90.8% in males and 94.1% in females postoperatively. The survival rate of male patients were 92.8% and that of female patients were 98.1%. Conclusions: The mean operative time and the blood loss were not significantly different between male and female patients. Postoperative CE angle tended to be smaller in male than female patients. The survival rate was not significantly different between males and females. Gender difference did not affect the clinical outcomes of ERAO in patients with hip dysplasia. Keywords: Gender difference, Periacetabular osteotomy, Hip dysplasia, Clinical outcome, Radiographic evaluation, Survival rate Accepted: April 25, 2014
INTRODUCTION Various types of periacetabular osteotomies have been proposed to treat acetabular dysplasia for young and active patients (1-4). Good or excellent long-term clinical and radiographic results have been reported (5-9). The authors
have been implementing eccentric rotational acetabular osteotomy (ERAO) since 1989 (10). ERAO is a variation on rotational acetabular osteotomy (RAO) proposed by Ninomiya and Tagawa (2), the acetabulum is osteotomised concentrically, the acetabular bone fragment is rotated, and the femoral head is distalised by the bulk bone graft
© 2014 Wichtig Publishing - ISSN 1120-7000
631
The outcomes of periacetabular osteotomy compared with males and females
from the ilium, allowing the femoral head to be covered with physiological cartilage. The authors have reported good and excellent clinical results (10-13), but we have included far fewer cases of this procedure on male patients than on female patients. The anatomical gender differences are that males demonstrate significantly less anteversion than females and the global version was significantly different between male and female pelvises (14). Males have greater muscle mass than females and increase their muscle mass at an accelerated rate in comparison to females as their weight increases (15). The authors considered that these gender difference, might affect the operative procedure and clinical outcomes. Complication rates may be different between male and female patients in total hip arthroplasty (16-18) but few reports exist on the gender difference in periacetabular osteotomy (19, 20). Therefore, the authors investigated the gender difference of ERAO to treat acetabular dysplasia for radiological evaluations and clinical outcomes. In this study, the following two questions were posed: 1) is it more difficult to rotate and fix the acetabular fragment in the optimal place in male patients than in female patients when performing ERAO; and 2) as a result, are surgical results worse for male than for female patients?
MATERIALS AND METHODS Thirty-four cases (36 joints) of male patients underwent ERAO in two hospitals between 1989 and 2007. One surgeon (HY) either performed or supervised all of these operations. The clinical records of the patients were reviewed retrospectively. All patients underwent physical examination and radiographic assessment on a regular schedule every six to 12 months in the outpatient department. The study received the approval of the local Ethics Committee. The stage of osteoarthritis was classified according to the criteria established by the Japanese Orthopedic Association (21). Three joints had stage 1 (no osteoarthritic change), 21 had stage 2 (slight narrowing of the joint space associated with sclerosis of the subchondral bone), and 12 had stage 3 (narrowing of the joint space associated with cystic lucencies and small osteophytes in the femoral head and acetabulum). The patients’ mean height was 167 ± 5.7 cm, their mean weight was 62.8 ± 6.0 kg, and their mean body 632
TABLE I - PATIENTS DATA
No. of patients (hips)
Male
Female
36
72
The stage of osteoarthritis
1.0000
stage1
3
6
stage2
21
42
stage3
12
24
Mean age (yr)
p value
35.8 (14-54) 35.9 (13-58)
0.9353
Mean duration of follow-up (yr)
13.2 (5-21)
13.4 (5-20)
0.8271
body height (cm)
167
156
DOI: 10.5301/hipint.5000158
ORIGINAL ARTICLE
Gender difference does not affect the outcomes of eccentric rotational acetabular osteotomy used in hip dysplasia Takafumi Amano1, Yukiharu Hasegawa2, Taisuke Seki1, Jin Yamaguchi3, Toshiki Iwase4 Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya - Japan Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya - Japan 3 Department of Orthopaedic Surgery, Chubu-Rosai Hospital, Nagoya - Japan 4 Department of Orthopaedic Surgery, Hamamatsu Medical Center, Hamamatsu - Japan 1 2
Introduction: Various types of periacetabular osteotomies have been proposed to treat acetabular dysplasia for young and active patients. Acetabular dysplasia is prevalent in women and rare in men, therefore few reports exist concerning periacetabular osteotomy of male patients. The purpose of this study is to clarify the gender differences in surgical techniques, radiographic and clinical outcomes. Materials and methods: Between 1989 and 2007, we performed 530 eccentric rotational acetabular osteotomies and followed them annually for more than five years. Thirty-six male patients were investigated. As a control group, 72 female patients were matched for age and preoperative stage of osteoarthritis at the time of surgery. We evaluated operative time and blood loss, radiographic parameters, Harris Hip Score (HHS) and survival rate. We investigated the clinical and radiographic differences between men and women. Results: The mean operative time was 148 min in males and 135 min in females. The bleeding during surgery was 445 g in males and 351 g in females. HHS improved 94.1 points in males and 93.5 points in women postoperatively. The mean CE angle improved 31.7° in males and 35.1° in females. The mean AHI was 90.8% in males and 94.1% in females postoperatively. The survival rate of male patients were 92.8% and that of female patients were 98.1%. Conclusions: The mean operative time and the blood loss were not significantly different between male and female patients. Postoperative CE angle tended to be smaller in male than female patients. The survival rate was not significantly different between males and females. Gender difference did not affect the clinical outcomes of ERAO in patients with hip dysplasia. Keywords: Gender difference, Periacetabular osteotomy, Hip dysplasia, Clinical outcome, Radiographic evaluation, Survival rate Accepted: April 25, 2014
INTRODUCTION Various types of periacetabular osteotomies have been proposed to treat acetabular dysplasia for young and active patients (1-4). Good or excellent long-term clinical and radiographic results have been reported (5-9). The authors
have been implementing eccentric rotational acetabular osteotomy (ERAO) since 1989 (10). ERAO is a variation on rotational acetabular osteotomy (RAO) proposed by Ninomiya and Tagawa (2), the acetabulum is osteotomised concentrically, the acetabular bone fragment is rotated, and the femoral head is distalised by the bulk bone graft
© 2014 Wichtig Publishing - ISSN 1120-7000
631
The outcomes of periacetabular osteotomy compared with males and females
from the ilium, allowing the femoral head to be covered with physiological cartilage. The authors have reported good and excellent clinical results (10-13), but we have included far fewer cases of this procedure on male patients than on female patients. The anatomical gender differences are that males demonstrate significantly less anteversion than females and the global version was significantly different between male and female pelvises (14). Males have greater muscle mass than females and increase their muscle mass at an accelerated rate in comparison to females as their weight increases (15). The authors considered that these gender difference, might affect the operative procedure and clinical outcomes. Complication rates may be different between male and female patients in total hip arthroplasty (16-18) but few reports exist on the gender difference in periacetabular osteotomy (19, 20). Therefore, the authors investigated the gender difference of ERAO to treat acetabular dysplasia for radiological evaluations and clinical outcomes. In this study, the following two questions were posed: 1) is it more difficult to rotate and fix the acetabular fragment in the optimal place in male patients than in female patients when performing ERAO; and 2) as a result, are surgical results worse for male than for female patients?
MATERIALS AND METHODS Thirty-four cases (36 joints) of male patients underwent ERAO in two hospitals between 1989 and 2007. One surgeon (HY) either performed or supervised all of these operations. The clinical records of the patients were reviewed retrospectively. All patients underwent physical examination and radiographic assessment on a regular schedule every six to 12 months in the outpatient department. The study received the approval of the local Ethics Committee. The stage of osteoarthritis was classified according to the criteria established by the Japanese Orthopedic Association (21). Three joints had stage 1 (no osteoarthritic change), 21 had stage 2 (slight narrowing of the joint space associated with sclerosis of the subchondral bone), and 12 had stage 3 (narrowing of the joint space associated with cystic lucencies and small osteophytes in the femoral head and acetabulum). The patients’ mean height was 167 ± 5.7 cm, their mean weight was 62.8 ± 6.0 kg, and their mean body 632
TABLE I - PATIENTS DATA
No. of patients (hips)
Male
Female
36
72
The stage of osteoarthritis
1.0000
stage1
3
6
stage2
21
42
stage3
12
24
Mean age (yr)
p value
35.8 (14-54) 35.9 (13-58)
0.9353
Mean duration of follow-up (yr)
13.2 (5-21)
13.4 (5-20)
0.8271
body height (cm)
167
156
