Seventh SICOT/SIROT Annual International Conference & SOF Ortopediveckan 2010 Abstracts Oral Presentations 31 August – 3 September 2010 Swedish Exhibition & Congress Centre Gothenburg, Sweden Date: 2010-08-31 Session: Symposium - Joint Preserving Operations & Osteotomies for Adult Hip Diseases Time: 13:30-15:00 Room: Congress Hall Abstract number: 26853 POSTERIOR ROTATIONAL OSTEOTOMY IN YOUNG ADULTS AND ADOLESCENTS WITH SEVERE OSTEONECROSIS Takashi ATSUMI, Satoshi TAMAOKI, Ryosuke NAKANISHI, Eiji KATOH, Minoru WATANABE, Toshihisa KAJIWARA Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama (JAPAN) Preservation of joint of femoral head necrosis with extensive lesion and apparent collapse in young adults and adolescents are generally thought to be difficult. The advantages of posterior rotational osteotomy are; The posterior column artery is shifted medially without vascular damage, thus, high degree posterior rotation is possible. The necrotic area is transferred to the postero-medial non-weight bearing portion. Postoperative uncollapsed anterior viable areas are moved to the loaded portion below the acetabular roof in flexed positions. After posterior rotation, congruency can be expected in a flexed position of daily life. 85 hips of 66 young adults(less than 50 years old) with extensive necrosis treated by posterior rotational osteotomy were reviewed with more than 5 year follow up with a mean of 9 years. 13 hips of 12 adolescents with extensive necrosis with apparent collapse treated by posterior rotational osteotomy were also reviewed with a mean of 6.5 years. All hips had extensive lesion on loaded portion preoperatively. Necrotic lesions were extended anteriorly to posteriorly. The mean age was 31 years (18-49) in adults and was 14 years in adolescents. 59 hips were non-traumatic, and 26 were traumatic in adults, 6 were followed SCFE, 3 were traumatic, 3 were after steroids treatment, 1 was Perthes’ disease in adolescents. A mean degree of posterior rotation was 121. Recollapse was prevented in 77 hips (91%) of adults, and 13 hips of adolescents on final AP radiographs. Progressive joint narrowing was found in 16 hips of adults. Resphericity of the postoperative transferred medial collapsed femoral head on final AP radiographs was observed on 52 of 58 hips with collapsed area moved medially in adults, and on 10 hips of adolescents. This operation appeared to be effective for remodeling and in delaying the progression of degeneration in young patients with extensive lesions. 2 Date: 2010-08-31 Session: Symposium - Joint Preserving Operations & Osteotomies for Adult Hip Diseases Time: 13:30-15:00 Room: Congress Hall Abstract number: 26843 CURVED INTERTROCHANTERIC VARUS OSTEOTOMY FOR NON-TRAUMATIC OSTEONECROSIS OF THE FEMORAL HEAD Yukiharu HASEGAWA, Taisuke SEKI Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya city (JAPAN) The purpose of this study is to investigate the clinical and radiographic outcomes of curved intertrochanteric varus osteotomy (CIVO) for non-traumatic osteonecrosis of the femoral head (ONFH) in cases with longer than a 5-year follow-up. A total of 64 patients with 67 hips were investigated. The average age was 39.2 years. The mean postoperative period was 8.3 years (5 to 18). Disease classification of the Japanese Investigation Committee: 5 hips were of Type B, 51 hips were of Type C1, and 11 hips were of Type C2. With regard to the staging: 25 hips were Stage 2, 29 hips were Stage 3A, 10 hips were Stage 3B, and 3 hips were in Stage 4. The indications of CIVO were for cases in which the weight bearing area was classified as Type B upon maximum abduction in image findings from AP radiographs of the hip joint.The mean Harris hip score improved from 69.7 points before surgery and to 85.6 points at final follow-up. The mean varus angulation was 27.1 degrees. The intact ratio was 14.4% before surgery, improving to 45.8% following surgery. Conversion to THA was performed for 4 hips. Collapse had progressed in 11 hips from the preoperative stage. A Kaplan-Meier survivorship analysis showed a 10-year postoperative survivorship of 95.5%, with the end point defined as conversion to THA. With the end point defined as the progression of collapse, the 10-year postoperative survivorship was 80.1%. If the postoperative intact ratio was 35% or higher, a progression of collapse was not significantly observed (p=0.017). When 1/3 of the outer part of the femoral head remains intact upon maximum abduction based on the image findings from AP radiographs of the hip joint, then good postoperative results can be expected. 3 Date: 2010-08-31 Session: Symposium - Joint Preserving Operations & Osteotomies for Adult Hip Diseases Time: 13:30-15:00 Room: Congress Hall Abstract number: 26858 TRANSPOSITION OSTEOTOMY OF THE ACETABULUM FOR THE HIP OSTEOARTHRITIS DUE TO THE ACETABULAR DYSPLASIA Seiya JINGUSHI Kyushu Rosai Hospital of Japan Labour Health and Welfare Organization, Kitakyushu (JAPAN) The patients with hip osteoarthritis in Japan are unique in comparison to those in Caucasians. Most patients are assessed to have acetabular dysplasia as the etiology; the patient distribution thus peaks for middle-aged patients and not elderly patients (1). Poor coverage of the femoral head causes supero-lateral subluxation followed by incongruity and instability of the joint. This causes abnormal shear stress or high pressure on the weight-bearing articular cartilage, and osteoarthritic changes occur. The disease will deteriorate unless such a biomechanical abnormality is corrected. Transposition osteotomy of the acetabulum (TOA), which has been developed by Nishio in 1955 (2), is the first periacetabular osteotomy to be performed in which the acetabulum is transposed with articular cartilage. TOA improves the coverage of the femoral head and restores congruity and stability of the joint to enable improvement of symptoms and prevention of osteoarthritis deterioration. Additionally, this osteotomy causes regeneration of the injured articular cartilage. TOA is a promising treatment option for osteoarthritis hips even at an advanced stage when preoperative radiographs at abduction of the hip show good congruity or containment of the joint (3). References: 1. Jingushi S, et al.: A Multi-institutional Epidemiologic Study Regarding Osteoarthritis of the Hip in Japan. J Orthop Sci 2010 (in print). 2. Nishio A. Transposition osteotomy of the acetabulum for the treatment of congenital dislocation of the hip. Nippon Seikeigekagakkai Zasshi 1956; 30:482-4 (in Japanese). 3. Matsuo A, Jingushi S, et al.: Transposition Osteotomy of the Acetabulum for Advanced Stage Osteoarthritis of the Hips. J Orthop Sci 2009; 14:266-273 4 Date: 2010-08-31 Session: Symposium - Joint Preserving Operations & Osteotomies for Adult Hip Diseases Time: 13:30-15:00 Room: Congress Hall Abstract number: 26814 LONG-TERM OUTCOME OF ROTATIONAL ACETABULAR OSTEOTOMY: 88 HIPS FOLLOWED FOR 15-22 YEARS Yuji YASUNAGA 1, Mitsuo OCHI 2 1Department of Artificial Joints & Biomaterials, Hiroshima Univ., Hiroshima (JAPAN), 2Department of Orthopaedic Surgery, Hiroshima Univ., Hiroshima (JAPAN) BACKGROUND: Satisfactory intermediate and long-term results of periacetabular osteotomy for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study was to examine the long-term results of rotational acetabular osteotomy (RAO) in patients with pre- or early-stage osteoarthritis secondary to developmental dysplasia of the hip. METHODS: We performed a retrospective review of the results of RAO in eighty patients (eighty-eight hips). All of the patients had radiographic evidence of pre- or early-stage osteoarthritis according to the staging system of the Japanese Orthopaedic Association. Seventy-three patients were female, and seven were male. The mean age was 35 (13-58) years at the time of surgery, and the mean duration of follow-up was 17.5 (15-22) years. Clinical follow-up was performed with use of the system of Merle d'Aubigné and Postel. The center-edge angle, acetabular roof angle, and head lateralization index were measured on radiographs made preoperatively and postoperatively. Postoperative joint congruency was classified into four grades. RESULTS: The mean preoperative Merle d'Aubigné clinical score was 14.3 points, which improved to a mean of 16.2 points at the time of the latest follow-up (p < 0.0001). The mean center-edge angle improved from -0.4 degrees preoperatively to 34 degrees (p < 0.0001), the mean acetabular roof angle improved from 29 degrees to 2.0 degrees (p < 0.0001), the mean head lateralization index improved from 0.65 to 0.60 (p < 0.01). Thirteen hips had radiographic evidence of progression of osteoarthritis. Kaplan-Meier survivorship analysis, with radiographic signs of progression of osteoarthritis as the end point, predicted a twenty-year survival rate of 78.0%. CONCLUSIONS: The long-term outcome of RAO was satisfactory for a dysplastic hip with pre- or early-stage osteoarthritis. 5 Date: 2010-08-31 Session: Shoulder / Elbow Time: 13:30-15:00 Room: H1 Abstract number: 26530 BONY BANKART IS A POSITIVE PREDICTIVE FACTOR AFTER PRIMARY SHOULDER DISLOCATION Björn SALOMONSSON, Anders VON HEIJNE, Mats DAHLBORN, Hassan ABBASZADEGAN, Susanne AHLSTRÖM, Nils DALÉN, Ulf LILLKRONA Karolinska Institutet, Stockholm (SWEDEN) Introduction: It would be a great advantage if it were possible to categorise the patients with first time dislocations to an initial treatment with the most beneficial outcome. MRI could be a useful method for finding lesions after shoulder dislocation. Patients and Methods: Fifty-eight patients with traumatic anterior shoulder dislocation were treated by closed reduction and were examined by MRI after a maximum of 2 weeks. The hemarthrosis or effusion present in the joint after the primary dislocation could be used as a contrast for arthrography to identify the lesions present on MRI. Results: At follow-up more than 8 years later, the MRI findings were compared to the shoulder function, shoulder stability, Rowe score and Western Ontario Shoulder instability Index (WOSI).