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| During
the past 15 years there has been a renewed and growing interest in adult
hip osteotomy. Osteotomy was used more frequently as a treatment for adult
hip problems before the advent of Charnley's low friction arthroplasty
(the first successful artificial hip joint) in the 1960's. The encouraging
early good results regarding function and pain relief after Charnley total
hip replacement in young patients led many surgeons to abandon osteotomy.
Osteotomy was considered to be difficult and have results that were less
predictable and less satisfactory to the patient. Despite the good initial results of total hip replacement, the long-term follow up of these patients has shown increasing problems, especially in the young active population. Osteolysis (bone loss) associated with loosening of the bone to hip prosthesis (artificial hip) bond plagues those patients who outlive the longevity of their artificial hip. Hip revision surgery for the failed total hip can present significant problems particularly for the patient with osteolysis. These failures of Charnley’s hip prosthesis have stimulated the production of hundreds of new hip prosthesis designs to solve the problems of loosening and osteolysis. Unfortunately, the overwhelming majority of new designs have not performed as well as the original Charnley prosthesis, and none have been proven better in long term follow of young patients. Therefore, despite that the modern hip replacement has been used for more than 30 years, its problems for active young to middle aged adults have underscored the importance of preserving the hip rather than replacing it. Osteotomy should not be thought of as an inferior second choice to total hip replacement that the young patient with early arthritis must undergo because he or she is too young for total hip replacement. The results after PAO, which preserves the patient's own hip, justify its use and the long term results can be better than what the patient could have obtained from a hip replacement. The patient's own hip is a living tissue with self-maintenance capabilities, whereas deterioration with time is inevitable for an artificial part. The sensory capabilities of the joint are preserved and the patient can continue to remain as active as symptoms or their lack of permits. The patient with a total hip replacement, however, always must be cautioned regarding possible hip dislocation and be restricted from vigorous activity. |
From 1987 through 2006
Dr. Matta performed 135 periacetabular osteotomies. Final follow-up of
these patients has shown the results of examination to be:
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The majority of patients
with poor results did not have an immediate poor result but were benefited
by the PAO for a variable period (up to 12 years) before requiring further
surgery. |
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| For patients who develop a poor result some time after their PAO surgery the cause is typically advancing hip arthritis. These patients are almost always best treated by total hip replacement surgery. For these patients the previous PAO has typically enhanced the acetabular bone with the increased femoral head coverage. Enhancement of a dysplastic acetabulum contributes to the success of a later total hip replacement by making the stability of the prosthetic acetabulum more reliable. | ||
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