title: High survival of dome pelvic osteotomy in patients with early osteoarthritis from hip dysplasia.
abstract: BACKGROUND
  The Chiari osteotomy reportedly has a 60% to 91% survival rate at a minimum 20 years followup. The dome pelvic osteotomy (DPO) has the advantage of allowing a larger weightbearing surface, and congruity in the sagittal plane presumably would reduce the joint contact stress and perhaps increase longevity.
  
  
  OBJECTIVE
  We determined: (1) the survival after DPO at a minimum 25-year followup, (2) patient function, (3) acetabular coverage, and (4) factors influencing conversion to THA.
  
  
  METHODS
  We retrospectively reviewed 50 patients (59 hips) with developmental dysplasia of the hip (DDH) treated with DPO. The preoperative radiographic stages were graded as prearthritis (18 hips), early osteoarthritis (25 hips), and advanced osteoarthritis (16 hips). We performed a Kaplan-Meier survival analysis with THA conversion as the end point. We determined various radiographic parameters reflecting coverage, and compared demographic information for hips without and with THA conversion using multivariate logistic regression analysis. The minimum followup was 25 years (mean, 27.5 years; range, 25-32 years).
  
  
  RESULTS
  Survival for all hips was 63.6% (95% CI, 51-76) at 27.5 years and that for hips with prearthritis and early osteoarthritis before the surgery was 79.1% (95% CI, 63-91). Twenty-one hips (36%) had undergone THAs at a mean 18.3 years (range, 2.5-25 years). At the last followup, pain, walking ability, and acetabular coverage improved. We identified four factors predicting THA conversion: greater age, presence of a preoperative Trendelenburg sign, higher preoperative radiographic osteoarthritis grade, and smaller postoperative acetabular head index (AHI) predicted conversion to THA.
  
  
  CONCLUSIONS
  DPO is a reasonable treatment option for patients with DDH and prearthritis or early osteoarthritis, with high survival at greater than 25 years.
authors.affiliation: Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita 565-0871, Japan. tsakai-osk@umin.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakai
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishii
authors.forename: Masaki
authors.initials: M
authors.lastname: Takao
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohzono
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Sugano
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D001696:Biomechanical Phenomena; D005260:Female; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking; D016474:Weight-Bearing; D055815:Young Adult