Joint-preserving operations for elderly patients with advanced and late-stage coxarthritis

Forty-one hips in 38 elderly patients with osteoarthritis of the hips, operated on with joint preserving techniques at the age of 55 years or more, were analyzed clinically radiologically. Bilateral involvement was seen in 13 cases. Ten hips were operated on after this study, before the patients were 55 years old, or no operation has yet been done. The average age at operation was 59 years, and the average preoperative hip scores (Merle d'Aubigné) were as follows: pain 2.8; range of motion (ROM) 4.4; gait 3.4. Average preoperative hip flexion and abduction were 88 degrees and 20 degrees respectively. Mean follow-up period was 57 months, and mean final hip scores were: pain 5.1; ROM 4.6; gait 4.0. Significant improvement was seen in pain and gait scores but no improvement in ROM scores. Excellent and good scores were achieved in half of the cases. Failure was seen in four cases. Hip pain recurred in nine patients. Five out of these patients were classified as atrophic according to Bombelli's classification of osteoblastic response of osteoarthritis of the hip. The responsiveness of the femoral head influenced the clinical results of the joint-preserving operations.