Related Experiment Video
Updated: Aug 7, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Bilateral varus osteotomies in hip deformities: are early interventions superior? A long-term follow-up
1Department of Orthopaedic Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. info@osteotomie.nl
Insights
Early prophylactic osteotomy for hip dysplasia (coxa valga with excessive femoral anteversion and acetabular dysplasia) can lead to better long-term outcomes compared to delayed surgery for osteoarthritis.
Area of Science:
- Orthopedics
- Hip Surgery
- Osteoarthritis Research
Background:
- Coxa valga with acetabular dysplasia is a known cause of early hip osteoarthritis.
- Optimal surgical timing for osteotomy in such cases remains a subject of study.
Purpose of the Study:
- To evaluate the long-term outcomes of early prophylactic osteotomy versus delayed therapeutic osteotomy in patients with symmetrical hip deformities.
- To determine the correlation between preoperative factors and surgical outcomes.
Main Methods:
- Retrospective analysis of 26 patients with symmetrical hip deformities undergoing osteotomy.
- Comparison of outcomes between hips receiving primary therapeutic osteotomy and those receiving early prophylactic osteotomy.
- Radiological evaluation and correlation analysis of clinical factors with outcomes.
Main Results:
- Early osteotomy group showed a significantly lower rate of conversion to total hip replacement (THR) compared to the primary osteotomy group (6 vs. 14 hips, P<0.05).
- Average follow-up was 19.9 years.
- Age, preoperative osteoarthritis grade, Merle d'Aubigne score, and excessive femoral anteversion were significant predictors of outcome.
Conclusions:
- Early prophylactic varus osteotomy in patients with coxa valga, excessive femoral anteversion, and acetabular dysplasia can yield superior results compared to delayed surgery.
- Timely intervention may prevent or delay the progression of osteoarthritis, reducing the need for THR.
Abstract:
Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but there were only minor to no complaints. We advised and performed an early osteotomy on these hips. On radiological evaluation, an average Sharp angle of 42.2 degrees and an average CCD of 142 degrees was present. During an average follow-up period of 19.9 years (range 15.0-25.9), 14 hips were converted to THR after the primary osteotomy, whereas there were only 6 after the early osteotomy (chi-square P<0.05). Using a Pearson correlation analysis, the age, preoperative grade of OA, preoperative Merle d'Aubigne score and excessive femoral anteversion were significantly correlated with the outcome. Our results show that the effect of an early, more prophylactic varus osteotomy in patients with a coxa valga with excessive femoral anteversion and acetabular dysplasia can be superior to the results achieved when surgery is postponed until the complaints and arthrosis have become more severe.
