JOA - 2026-05-20 - Journal Article
Outcomes of Rotational Acetabular Osteotomy Combined with Femoral Valgus Wedge Osteotomy for Osteoarthritis of the Hip: A Median 23-year Follow-Up Study of 47 Hips.
Yoshikawa Y, Okano I, Usui Y, Nishi M, Nakamura S, Kudo Y
Topics
Key Takeaway
RAO combined with FVWO achieved 85.9% THA-free survival at 20 years, with Tönnis grade 2 preoperatively and larger postoperative acetabular roof angle independently predicting failure.
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Summary
This single-institution retrospective study evaluated long-term outcomes of RAO combined with FVWO for symptomatic secondary OA (Tönnis grade ≤2) with femoral head deformity in DDH patients operated between 1986 and 2010. Twenty-year survival was 85.9% using THA conversion as endpoint and 67.2% using progression to Tönnis grade 3. Multivariable Cox regression identified preoperative Tönnis grade 2 and larger postoperative acetabular roof angle as independent predictors of both endpoints.
Key Limitation
Single-institution series spanning 24 years introduces substantial surgeon learning curve and implant/technique heterogeneity that limits generalizability of the identified acetabular roof angle threshold.
Original Abstract
BACKGROUND
Rotational acetabular osteotomy (RAO) combined with femoral valgus wedge osteotomy (FVWO) is a joint-preserving option for patients who have developmental dysplasia of the hip (DDH) accompanied by femoral head deformity, as well as for those who have advanced secondary osteoarthritis (OA). This study aimed to identify significant predictors of long-term outcomes after this procedure in a cohort with a median 23-year follow-up, with conversion to total hip arthroplasty (THA) as the primary outcome and progression to end-stage OA as the secondary outcome.
METHODS
We retrospectively reviewed patients who have symptomatic secondary OA of Tönnis grade ≤ 2 accompanied by femoral head deformity who underwent RAO combined with FVWO at a single institution between 1986 and 2010. Survivorship was calculated with progression to Tönnis grade 3 and conversion to THA as the endpoints. Univariable Cox proportional hazards regression analyses were performed to evaluate prognostic factors, including patient characteristics, postoperative acetabular coverage, and femoral head morphology. There were two variables considered clinically relevant among those identified in the univariable analyses entered into a multivariable Cox proportional hazards model.
RESULTS
The final analysis included 45 patients and 47 hips. The 20-year survival rates were 67.2% with progression to Tönnis grade 3 and 85.9% with conversion to THA as the endpoints. In the univariable analyses, age at surgery, preoperative OA grade, and postoperative acetabular roof angle were identified as significant predictors of both endpoints. In the multivariable analysis including preoperative OA grade and postoperative acetabular roof angle selected based on the univariable analyses, both variables remained significant predictors of each endpoint.
CONCLUSION
In this cohort, the 20-year joint preservation rate without conversion to THA exceeded 80%. Preoperative Tönnis grade 2 and a larger postoperative acetabular roof angle were identified as significant predictors of progression to Tönnis grade 3 and conversion to THA.