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Middle-term results of simultaneous bilateral femoral osteotomies for advanced bilateral coxarthritis
1Department of Rehabilitation Medicine, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
Insights
Simultaneous hip osteotomies, including Maquet
Area of Science:
- Orthopedic Surgery
- Hip Osteoarthritis Treatment
- Reconstructive Surgery
Background:
- Bilateral hip osteoarthritis treatment via osteotomy is controversial due to potential contralateral hip deterioration.
- A novel approach aimed to treat osteoarthritis while preventing further deterioration of the contralateral hip.
Purpose of the Study:
- To evaluate the efficacy and safety of simultaneous bilateral femoral osteotomies for advanced hip osteoarthritis.
- To assess if combined Pauwels' valgus osteotomy and Maquet's operation can improve hip function without worsening the contralateral side.
Main Methods:
- Eighteen patients underwent simultaneous bilateral hip operations (Pauwels' valgus osteotomy and Maquet's operation).
- Patients were followed for a mean of 105 months, with clinical and radiographic assessments.
- Weight-bearing protocols were implemented post-surgery to manage rehabilitation.
Main Results:
- Significant improvements in hip scores were observed for both osteotomy types.
- Two-thirds of hips maintained a high functional score (>70 points) at final follow-up.
- Kaplan-Meier analysis indicated joint space width maintenance for 10 years in congruous joints.
Conclusions:
- Simultaneous bilateral femoral osteotomies represent a viable alternative to bilateral total hip arthroplasty for late-stage hip osteoarthritis.
- This combined surgical approach may offer improved outcomes and preserve joint function.
Background:
Osteotomy as a treatment for bilateral osteoarthritis of the hip is controversial because of deterioration of the contralateral side. We tried to not cause the contralateral hip to deteriorate even more while curing osteoarthritis by simple methods (release of iliopsoas and adductor longus muscle tendons and lateral transfer of the greater trochanter; Maquet's operation) during the rehabilitation period of Pauwels' valgus osteotomy.
Methods:
Eighteen patients (17 women, 1 man; mean age, 49 years) were indicated for bilateral operations performed simultaneously from 1984 to 2001 and followed for more than 3 years (mean, 105 months; range, 36-188 months). They were analyzed clinically (hip score of Hospital for Special Surgery) and radiographically. Pauwels' valgus osteotomy was indicated for 18 hips with or without additional operations. Maquet's operation was performed simultaneously on all contralateral sides. Three weeks after the operations, the Maquet's operation side was fully weight-bearing and the other side was under controlled weight-bearing for 1 year.
Results:
The mean hip score of the valgus osteotomy side was 36 points before the operation and 73 points at the final follow-up, respectively; that of Maquet's operation side was 44 and 77 points, respectively. Two-thirds (24 of 36) of the hips maintained more than 70 points of hip score at the final follow-up. Four hips were converted to total hip arthroplasty. Kaplan-Meier survivorship analysis revealed that the congruous joint maintained its joint space width for 10 years.
Conclusions:
Bilateral simultaneous femoral osteotomies for the late stages of osteoarthritis could be an alternative to bilateral total hip arthroplasties.