Long-term results of the dial osteotomy in the treatment of high-grade acetabular dysplasia.
The dial osteotomy, an acetabular reorientation procedure based on radiographs, was developed by R. H. Eppright for treatment of hip dysplasia; however, long-term results are not recorded. The aim of this study was to evaluate retrospectively the results of the dial osteotomy as done in 37 patients (44 hips) at an average followup of 12.6 years. Articular pressures with the application of a time and pressure algorithm were calculated from radiographs to correlate calculated intraarticular pressures with progression of degenerative disease. Clinical results at followup were 32 (73%) satisfactory and 12 (27%) unsatisfactory hips. Six (13%) hips failed between 10-20 years (average 14.7 years). A satisfactory result correlated with the preoperative functional score. Radiographically, the anterior center-edge angle increased from an average of 6.7 degrees to 37.9 degrees. At followup, radiographic indices of degeneration indicated that eight (18%) hips had improved, 18 (41%) had stabilized, and 18 (41%) had deteriorated. Severin indices improved in 21 (48%) hips. Joint space width at followup provided the only correlation between radiographic parameters and clinical result. Contact pressures were reduced from 4.45 MPa to 1.12 MPa. The cumulative exposure to articular pressures averaged 61.6 MPa-years, and did not correlate with radiographic parameters or clinical success.


METHODS
Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
Miller
Nancy H
NH
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA. nmillerb@jhmi.edu
Krishnan
S G
SG
Kamaric
Emir
E
Noble
Philip C
PC
D000077:Acetabulum / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011336:Probability; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome