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Comparison of Postoperative Outcomes of Rotational Acetabular Osteotomy Using Autografts and Allografts
Tsuguaki Hosoyama1, Nobuhiro Kaku1, Yutaro Shibuta1
1Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan.
Background:
Developmental dysplasia of the hip (DDH) contributes to the progression of hip osteoarthritis (OA), particularly in younger individuals. To delay OA development, joint-preserving procedures such as rotational acetabular osteotomy (RAO) improve hip stability by repositioning the acetabulum. Originally introduced by Ninomiya and Tagawa, RAO involves filling the osteotomy gap with autografts or allografts. Since 2013, our institution has transitioned from autografts to allografts. This study compares postoperative outcomes between these graft materials, as no prior studies have directly examined their efficacy.
Methods:
A retrospective analysis of 59 patients (62 hips) who underwent RAO for DDH between June 2006 and June 2022 was conducted. Patients with advanced OA, prior acetabular osteotomy, or inadequate follow-up were excluded. The cohort included 1 male and 58 female patients (mean age, 40.8 years). Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) hip score, while radiographic evaluations included center-edge (CE) angle, Sharp angle, acetabular roof obliquity (ARO), acetabular head index, joint space width, and graft thickness. Bone fusion was assessed using Knight's classification, and statistical comparisons were performed between autograft and allograft groups.
Results:
Preoperative JOA hip scores were comparable (autograft: 69 ± 14, allograft: 61.9 ± 15.5). At 1 year, both groups demonstrated significant improvement (autograft: 92.3 ± 6.2, allograft: 90.8 ± 6.0). Radiographic evaluations showed improved CE, Sharp angles, and ARO values in both groups, with no significant intergroup differences. Bone fusion progressed similarly, with trabecular reorientation occurring around 25 months. Joint survival rates were 93% at 15 years (autograft) and 100% at 10 years (allograft).
Conclusions:
RAO with autografts and allografts yielded similar favorable outcomes in early-stage hip OA. Both approaches improved hip function and morphology, with high survival rates. The allograft group maintained greater gluteus medius integrity and showed no OA progression after 10 years, suggesting that allografts are a viable, less invasive option. Further research is necessary to assess long-term outcomes and muscle preservation.