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Clinical outcomes of Chiari pelvic osteotomy for acetabular dysplasia, including conversion to total hip arthroplasty (THA), have not been adequately explored. The purpose of this study was to examine the long-term results and clinical outcomes of Chiari pelvic osteotomy as the primary outcome and to analyze its prognostic factors as the second outcome. This study was a multicenter, retrospective cohort study. Ninety-seven patients underwent Chiari pelvic osteotomy at three hospitals between March 1975 and October 1997. The long-term clinical outcomes of Chiari pelvic osteotomy, including conversion to THA and hip pain, were analyzed using the Kaplan–Meier method. In addition, the prognostic factors for conversion to THA after Chiari pelvic osteotomy were evaluated with clinical variables and radiographic parameters. The study included 51 hips in 45 patients (4 men and 41 women) with long-term follow-up. The survival rates assessed by Kaplan–Meier analysis with conversion to THA as an endpoint, were 90.2% (95% confidence interval (CI) 82.0–98.4%) at 20 years and 73.5% (95% CI 61.1–86.0%) at 30 years. In contrast, the Kaplan–Meier survival rates with the Japanese Orthopaedic Association hip score for pain ≤20 as an endpoint, were 86.3% (95% CI 76.8–95.7%) at 20 years and 65.6% (95% CI 52.3–79.0%) at 30 years. Only older age at osteotomy was the significantly poor prognostic factor for conversion to THA, with a hazard ratio of 1.11/year, 95% CI 1.06 to 1.18, (p < 0.01). Chiari pelvic osteotomy may still be a good alternative to bony reconstructive surgery for acetabular dysplasia especially in young patients. Only older age at the osteotomy was related to the poor prognosis of preserving hip function. [ABSTRACT FROM AUTHOR]

Purpose: The Chiari pelvic osteotomy was the first surgical procedure to address hip dysplasia by changing the position of the acetabulum by medialization, thus creating a bony roof and improving biomechanical conditions. The aim of this retrospective cohort study was to report on the very long-term results of this technique. Methods: Out of a consecutive series of 1536 hips, 504 in 405 patients were available for follow-up. The patients were assessed by physical and radiological examination. A Kaplan–Meier survival analysis with total hip arthroplasty as an endpoint was performed and stratified for age groups, pre-operative diagnosis, sex and osteoarthritis stage. Results: The average follow-up was 36 ± 8.1 years (range, 35.2 to 54). The average pain level on the Visual Analogue Scale was 2.9 ± 2.6 (range 0 to 8.7). The average Harris Hip Score was 80.2 ± 17.4 (range 17.4 to 100). Correction of dysplasia was effective and remained stable over time. Osteoarthritis significantly increased over time with 53% Tönnis grade 3 at follow-up. The cumulative survivorship was 79.8% (95% confidence interval (CI), 76.1–83.2%) at 20 years, 57.1% (95% CI, 52.8–61.8%) at 30 years and 35% (95% CI, 30.3–40.3%) at 40 years. Young age, male sex and low osteoarthritis grade were positive prognostic factors. Conclusions: Although the Chiari pelvic osteotomy is considered a salvage procedure nowadays, it achieved excellent long-term results even in indications, which would be treated differently today. Young patients without osteoarthritis had the best outcome. [ABSTRACT FROM AUTHOR]

Introduction: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). Methods: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6–21.3) years. Results: Mean age at surgery was 10.2 (range 8.2–17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65–100) points. An excellent functional outcome (HHS 90–100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. Conclusions: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients. [ABSTRACT FROM AUTHOR]

Spina bifida can result in lower-extremity motor and sensory deficits, often leading to hip joint dislocation, a significant disability. The optimal surgical approach for hip dislocation in spina bifida patients remains a subject of debate. A 12-year-old girl with thoracic-level spina bifida experienced recurrent hip dislocations, significantly impacting her daily life and sports activities. At the age of 13, she underwent a femoral varus osteotomy. However, after six months, her hip dislocated again. At the age of 14, she underwent a Chiari pelvic osteotomy in addition. Six years later, she exhibited no limitations in her daily activities and sports participation. We report the first successful treatment of recurrent hip dislocation in a spina bifida patient with thoracic-level involvement, utilizing a combination of femoral varus osteotomy and pelvic osteotomy. Prior to surgical intervention, not only a comprehensive assessment of the patient's physical examination but also an assessment of their goals and living environment are essential., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Sappro City General Hospital issued approval N/A. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yamanaka et al.)

Background: The modern indications for Chiari pelvic osteotomy (CPO) have narrowed and the number of such operations performed has diminished markedly. So far published long-term experience with CPO indicate the fact that in selected patients satisfactory functional results can be achieved. The aim of this study was to investigate the parameters which influence CPO survival and its conversion into total hip arthroplasty (THA). Methods: This is a single-centre retrospective case-series study. In the period from 1976 to 2012, it included 172 CPO in 158 patients. Of those, in 43 patients (48 hips) the follow-up was discontinued, leaving 115 patients (124 hips) for final analyses. The median age at the time of the surgery was 34 years, and the mean duration of the follow-up was 19 years. Results: In 115 patients (124 CPO) included in the study, a total of 51 THA was performed in 49 patients. The median period between CPO and THA was 14 years. Conclusion: Supporting our results, we suggest that CPO should still be indicated in a selected group of younger patients even with advanced stage of hip osteoarthritis who prefer a joint-conserving procedure and consent to a predicted less optimal outcome. [ABSTRACT FROM AUTHOR]

Background: Controversy exists whether previous pelvic osteotomies have negative effects on total hip arthroplasty (THA). This study evaluates the implant survival and patient-reported outcomes of THA after previous Chiari pelvic osteotomy (CPO).Methods: Data on 301 THAs after CPO were collected through clinical and radiological follow-up examinations and telephone interviews. The Kaplan-Meier survivorship analysis depicts implant survival.Results: Of this consecutive series of 1536 CPOs, follow-up was completed in 405 patients with 504 CPOs after a mean time of 36 years (±8; range, 22-54 years). At follow-up, 301 hips (60%) had already undergone THA. The overall survival of THA with revision as an end point after 10, 20, and 25 years was 93%, 76%, and 68%, respectively. The revision rate was 12%. The average period between THA and revision surgery was 9.6 years (±6.1; 4 months-25.4 years). The patient's age at revision was 57.9 years (±10; 33.2-78.5 years). Aseptic loosening was the most common of the known reasons for revision surgery.Conclusion: This retrospective study supports the hypothesis that prior CPO does not compromise the prerequisites for successful THA at a later stage. Survival rates of the implanted prosthesis are comparable to primary implanted hips, as overall survival was 93% after 10 years. [ABSTRACT FROM AUTHOR]

Congenital hip dysplasia often requires surgical interventions in younger adults. 3D-navigated, robotic-assisted surgery for total hip arthroplasty may be beneficial in cases of pseudo-acetabulum and preceding treatments (Chiari Pelvic osteotomy) due to better pre-surgical planning and higher levels of precision associated with the technology, which may be associated with positive effects regarding short-term and long-term clinical outcomes. Here, we report the case of a 26-year-old Caucasian woman with a Crowe-IV dysplastic hip and pseudo-acetabulum. Earlier interventions included Chiari pelvic osteotomy, femoral osteotomy and femoral lengthening, which did not improve pain and function in the longer term. The surgical approach via robot-assisted surgery lead to positive outcomes in the short-term (four months post-surgery) and medium-term (17 months post-surgery) in this specific case.

Introduction: Currently, the cover of the femoral head was mainly assessed using conventional plain films after Chiari pelvic osteotomy in most studies. The purpose of the current study was to observe whether the femoral head coverage measured by three-dimensional computed tomography (3D-CT) was consistent with the radiographic findings. Patients and methods: A total of 24 patients (24 hips) with an average age of 11.5 years, underwent Chiari osteotomy due to acetabular dysplasia, and 15 subjects (30 hips) of normal control with a mean age of 12 years were involved in the study. The pre- and postoperative coverage of femoral head was measured by using conventional plain film and 3D-CT on the anterior 1/4, middle 1/2, and posterior 1/4 coronal plane. The anterolateral, mediolateral and posterolateral coverage measured by 3D-CT were compared with the coverage measured by plain radiograph, and which were also compared with the normal control individuals. Results: The postoperative anterolateral, mediolateral coverage measured by 3D-CT was significantly smaller than that measured by radiography ( P < 0.01). No significant difference was found between the 3D-CT measurements on the posterolateral coverage and the radiographic results. The anterolateral femoral head coverage in the patients following Chiari pelvic osteotomy was also smaller than that in the normal control individuals ( P = 0.026). In contrast, the postoperative posterolateral coverage in the patients was more excessive than that in the normal control individuals ( P = 0.001). Conclusion: Conventional radiographs may show sufficient cover of the femoral head after Chiari osteotomy, whereas in fact, the cover may be not perfect, especially on the anterolateral part. Therefore, the postoperative 3D-CT is beneficial for evaluating the outcome of Chiari osteotomy, especially when the anterolateral coverage of femoral head is significantly insufficient preoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Many reports have suggested that Chiari pelvic osteotomy would improve the results of acetabular component placement and fixation in subsequent total hip arthroplasty. However, little is known concerning the biomechanical, radiological, and clinical effects of Chiari pelvic osteotomy on subsequent total hip arthroplasty. Materials and methods: Ten total hip arthroplasties for developmental dysplasia of the hip after previous Chiari pelvic osteotomy (Chiari group) were compared with 20 total hip arthroplasties for developmental dysplasia of the hip without previous surgery (control group). Preoperative patient demographic data and operative technique were well matched between the groups. The mean duration of follow-up was 3.0 years. Biomechanical, radiological, and clinical evaluations were performed. Results: No acetabular or femoral components exhibited loosening. All patients had good or excellent clinical score according to the Merle d'Aubigne-Postel rating system at the most recent follow-up. Abductor force and joint force were smaller in the Chiari group, although long operative time, more blood loss, and verticalization of joint force were noted in this group. Conclusion: This limited study suggested that Chiari pelvic osteotomy changed the biomechanical features of the hip joint, and that this alteration might have compromised subsequent total hip arthroplasty. [ABSTRACT FROM AUTHOR]

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Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: We performed cementless total hip arthroplasty combined with acetabular reconstruction with Chiari pelvic osteotomy on 3 hips in 2 patients. This procedure increased the osseous coverage of the shell and decreased the load around the hip by medialization of the hip center. Osteosynthesis of the proximal and distal bone fragment was performed using a shell with screws. Nonunion between the proximal and distal fragments was not noticed to include the case with small contact area. Postoperative dislocation had not occurred in these cases as of 1 year after surgery. This method may be an effective solution for severe dysplasia and revision surgery. [Copyright &y& Elsevier]