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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 5,
648-654.
doi: 10.1302/0301-620X.86B5.14653 Copyright © 2004 by British Editorial Society of Bone and Joint Surgery Pelvic remodelling after the Chiari osteotomyA LONG-TERM REVIEWM. F. Macnicol, MCh, FRCS Ed (Orth), Consultant Orthopaedic Surgeon1; H. K. Lo, FRCS Ed, Clinical Fellow2; and K. F. Yong, FRCS Ed, Clinical Fellow1
1 University Department of Orthopaedic Surgery, New Royal Infirmary, Little France, Old Dalkeith Road, Edinburgh, UK. Correspondence should be sent to Mr M. F. Macnicol. Survivorship analysis of 215 medial displacement pelvic osteotomies undertaken for symptomatic, incongruent dysplasia of the hip since 1966 showed that four of every five hips had not required conversion to a total hip arthroplasty. The radiological characteristics of 86 osteotomies were evaluated at a mean of 18 years (5 to 30) after surgery which was performed at the age of 15.9 ± 9.5 years. Revision was significantly (p < 0.05) more likely in those patients operated on after the age of 25 years. The centre-edge (CE) angle increased from 2.5 ± 13.9° before to 41.8 ± 15.0° immediately after operation. The increase in CE angle was maintained at later review (38.5 ± 16.5°). Even with severe dysplasia with a CE angle less than zero a substantial improvement in the cover of the femoral head was achieved, usually by medial shift of the lower pelvic fragment. However, the head was not invariably medialised by the osteotomy and lateral movement of the ilium was noted when the position of the joint was relatively medial before operation or when the hip was arthritic. In the longer term pelvic remodelling did not reverse the medialisation produced by the osteotomy, and the cover of the femoral head was maintained.
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