Μελέτη επί της συμβολής της οστεοτομίας πυελού κατα Chiari στην αντιμετώπιση της οστεοαρθρίτιδος του δυσπλασικού ισχίου των ενηλίκων

Abstract

The results of 52 Chiari pelvic osteotomies for early osteoarthritis in dysplastic hips in 45 women are described.The patients were 18 to 53 years old average 35 years and the follow up was 1 to 16 years average 8 years. Five hips had undergone secondary total hip replacement till now. The outcome was good and fair in 84% and poor in 16%. We discuss the indications of this procedure. Criteria for the Chiari pelvic osteotomy in young adults with dysplastic hips with or without early osteoarthritis were clinically the pain, the limp, and the small restriction of the range of movement of the hip. Flexion at least 90° without fixed flexion deformity and radiologically dysplastic hip joint. The results were evaluated according to the Merle d’ Aubigne and Postel method of evaluation in relation to the pain, the walking ability and the range of movement of the hip before and after the operation. We noticed improvement of the walking ability in 84% of the patients, and the pain disappeared or decreased in 84% of the patients also, while the range of movement of the joint didn’t change substantially. The good results were because we increased the surface of contact between the head of the femur and the new acetabulum and because of the reduction of the power that acts on the joint and comes from the body weight, because of the medialisation of the joint, so the stresses on the joint were decreased. For osteoarthritis secondary to hip dysplasia, the Chiari pelvic osteotomy is an alternative procedure to early hip replacement, especially in younger patients. In our experience, the Chiari osteotomy delays the need for T.H.R. and improves the anatomical conditions for this operation, which has an uncertain outcome in the young patient and in cases of deficient acetabular bone stock, and in contrast to intertrochanteric osteotomy it facilitates the implantation of the acetabular part of a total hip replacement and the femoral part of the artificial joint is much easier to be inserted because we don’t disturb the upper femur.