Adrian Radu-Radulescu

COPENHAGEN, Denmark — Total hip arthroplasties following intertrochanteric osteotomies result in higher intraoperative and postoperative complication rates and lower prosthesis survival rates at the 6-year mark, according to a study presented here.

Adrian Radu-Radulescu, MD, shared his team’s findings at the 12th EFORT Congress 2011.

Radu-Radulescu’s group worked with two cohorts. The first group consisted of 93 patients who underwent total hip arthroplasty (THA) after intertrochanteric osteotomy, with the second group — a control group — consisting of 93 patients who only underwent primary THA with the same implant and surgical team.

Osteotomy types in the study consisted of medial displacement (27), varisation (19), valgisation (18), flexion (25) and rotational (4). The team noted the duration of each surgical procedure as well as all technical intraoperative challenges, and determined Harris hip scores (HHS) at the 12-month and 3-year marks postoperatively. This was in addition to yearly clinical and radiological check-ups. Complications throughout the full follow-up — a mean of 77 months — were noted.

Average time between osteotomy and total hip replacement, the authors found, was 76 months. They also reported an average HHS at 1 year postoperatively of 88 in the first group and 93 in the second group. At the 3-year mark, these scores were 85 and 92, respectively.

“We can note in our results that after an average follow-up of 6 years, 6 patients in group one — the group with osteotomies — required revisions, while in the second group at 6 years this operation was not necessary,” Radu-Radulescu said, adding that revision indications were loosening of the femoral component in four cases and both components in two cases.

Regarding surgical duration, patients who underwent THA following osteotomy were in surgery almost twice as long as the control group.

“The results of hip arthroplasty in standard cases and in cases after osteotomies are pretty much the same in the first years after surgery, but the differences become more and more obvious after a few years because of loosening in the femoral component,” Radu-Radulescu said. “The survival rate of the prosthesis is significantly inferior in the group with osteotomies. Both the intraoperative and postoperative complication rates are far superior for those with standard arthroplasties.”

Reference:

• Radulescu R, Badila A, Nutiu O, et al. Clinical results of total hip arthroplasty after intertrochanteric osteotomy. Paper #2611. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.