Shelf acetabuloplasty is associated with longer survival of the total hip arthroplasty in patients with late-detected hip dislocation: a cohort study of 70 hips with a modified Spitzy shelf procedure
DOI:
https://doi.org/10.2340/17453674.2025.44036Keywords:
Developmental dysplasia of the hip (DDH), Spitzy acetabuloplasty, Total hip arthroplastyAbstract
Background and purpose: Our aim was to compare age at time of total hip arthroplasty (THA) and the THA survival time in patients with late-detected developmental dislocation and dysplasia of the hip (DDH) treated with traction in childhood who had either undergone acetabular shelf operation due to persistent DDH, or no previous acetabular surgery but persistent DDH, or no previous acetabular surgery and CE angle ≥ 18°.
Methods: 112 patients (97 females; 144 hips) with late-detected DDH who had undergone THA were studied. 70 hips had undergone a modified Spitzy procedure (SA group) at the age of 8–33 years. They were compared with 2 groups that had not undergone previous pelvic surgery: a “Dysplasia” group with residual (persistent) acetabular dysplasia (CE angle < 18°, 33 hips) and a “Normal” group with no residual dysplasia (37 hips). We analyzed age at THA and the survival rate (percentage of THAs not having undergone revision).
Results: Mean patient age at THA did not differ between the SA group (52 years) and the Dysplasia group (49 years; P = 0.1). 11 THAs had been revised in the SA group and 9 in the Dysplasia group. Kaplan–Meier analysis showed 20-year survival rates of 88% in the SA group and 68% in the Dysplasia group. The estimated survival time of THA was significantly higher in the SA group than in the Dysplasia group (29.4 and 19.8 years; P = 0.01). Mean age at THA was significantly lower in the Dysplasia group than in the Normal group (49 and 55 years), but there was no significant difference between these groups in estimated survival time of THA.
Conclusion: A previous acetabular shelf operation in patients with persistent DDH does not appear to delay age at THA but THA had better survival rate.
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References
Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand (Suppl 58) 1939; 83: 7-135.
Cooperman D R, Wallensteen R, Stulberg S D. Acetabular dysplasia in the adult. Clin Orthop Relat Res 1983; 175: 79-85. DOI: https://doi.org/10.1097/00003086-198305000-00013
Terjesen T. Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation. J Child Orthop 2011; 5: 425-31. doi: 10.1007/s11832-011-0370-2. DOI: https://doi.org/10.1007/s11832-011-0370-2
Ganz R, Klaue K, Vinh T S, Mast J W. A new periacetabular osteotomy for the treatment of hip dysplasia: technique and preliminary results. Clin Orthop Relat Res 1988; 232: 26-36. DOI: https://doi.org/10.1097/00003086-198807000-00006
Clohisy J C, Schutz A L, St John L, Schoenecker P L, Wright R W. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res 2009; 467: 2041-52. doi: 10.1007/s11999-009-0842-6. DOI: https://doi.org/10.1007/s11999-009-0842-6
Fawzy E, Mandellos G, De Steiger R, McLardy-Smith P, Benson M K D, Murray D. Is there a place for shelf acetabuloplasty in the management of adult acetabular dysplasia? A survivorship study. J Bone Joint Surg Br 2005; 87: 1197-1202. doi: 10.1302/0301-620X.87B9.15884. DOI: https://doi.org/10.1302/0301-620X.87B9.15884
Tanaka H, Chiba D, Mori Y, Kuwahara Y, Baba K, Yamada N, et al. Long-term results of a modified Spitzy shelf operation for developmental dysplasia of the hip in adults and adolescents. Europ J Orthop Surg Traumatol 2018; 28: 1341-7.
Spitzy H. Künstliche Pfannendachbildung. Z Orthop 1924; 43: 284-94. doi: 10.1007/s00590-018-2191-1. DOI: https://doi.org/10.1007/s00590-018-2191-1
Summers B N, Turner A, Wynn-Jones C H. The shelf operation in the management of late presentation of congenital hip dysplasia. J Bone Joint Surg Br 1988; 70: 63-8. doi: 10.1302/0301-620X.70B1.3276702. DOI: https://doi.org/10.1302/0301-620X.70B1.3276702
Holm A G V, Reikerås O, Terjesen T. Painless period after Spitzy shelf operation for residual hip dysplasia: a long-term study of 47 children and young adults. J Orthop 2018; 15: 196-200. doi: 10.1016/j.jor.2018.01.007. DOI: https://doi.org/10.1016/j.jor.2018.01.007
Fu M, Xiang S, Zhang Z, Huang G, Liu J, Duan X, et al. The biomechanical differences of rotational acetabular osteotomy, Chiari osteotomy and shelf procedure in developmental dysplasia of hip. BMC Musculoskel Disord 2014; 15: 47. doi: 10.1186/1471-2474-15-47. DOI: https://doi.org/10.1186/1471-2474-15-47
Holm A G V, Reikerås O, Terjesen T. Long-term results of a modified Spitzy shelf operation for residual hip dysplasia and subluxation: a fifty year follow-up study of fifty-six children and young adults. Internat Orthop (SICOT) 2017; 41: 415-21. doi: 10.1007/s00264-016-3286-0. DOI: https://doi.org/10.1007/s00264-016-3286-0
Bickel W H, Breivis J S. Shelf operation for congenital subluxation and dislocation of the hip. Clin Orthop Relat Res 1975; 106: 27-34. doi: 10.1097/00003086-197501000-00004. DOI: https://doi.org/10.1097/00003086-197501000-00004
Mori R, Yasunaga Y, Yamasaki T, Hamanishi M, Shoji T, Ochi M. Ten year results of transtrochanteric valgus osteotomy with or without the shelf procedure. Internat Orthop (SICOT) 2013; 37: 599-604. doi: 10.1007/s00264-013-1810-z. DOI: https://doi.org/10.1007/s00264-013-1810-z
Benad K, Martinot P, Dartus J, Girard J, Putman S, Migaud H. Influence of shelf acetabuloplasty on the outcomes of total hip arthroplasty in hips with dysplasia: a case-control study. Internat Orthop 2022; 46: 989-97. doi: 10.1007/s00264-022-05322-3. DOI: https://doi.org/10.1007/s00264-022-05322-3
Terjesen T. The natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH: 48 patients with closed reduction followed to a mean age of 62 years. Acta Orthop 2023; 94: 152-7. doi: 10.2340/17453674.2023.11664. DOI: https://doi.org/10.2340/17453674.2023.11664
Terjesen T. Residual hip dysplasia: is there a place for hip shelf operation?. J Child Orthop 2018: 12: 358-63. doi: 10.1302/1863-2548.12.180042. DOI: https://doi.org/10.1302/1863-2548.12.180042
Lerch D, Steppacher S D, Liechti F, Tannast M, Siebenrock K A. One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res 2017; 475: 1154-68. doi: 10.1007/s11999-016-5169-5. DOI: https://doi.org/10.1007/s11999-016-5169-5
Engesæter L B, Engesæter I Ø, Fenstad A M, Havelin L I, Kärrholm J, Garellick G, et al. Low revision rate after total hip arthroplasty in patients with pediatric hip diseases. Acta Orthop 2012; 83: 436-41. doi: 10.3109/17453674.2012.736171. DOI: https://doi.org/10.3109/17453674.2012.736171
Wainwright D. The shelf operation for hip dysplasia in adolescence. J Bone Joint Surg Br 1976; 58: 159-63. doi: 10.1302/0301-620X.58B2.932076. DOI: https://doi.org/10.1302/0301-620X.58B2.932076
Migaud H, Chantelot C, Giraud F, Fontaine C, Duquennoy A. Long-term survivorship of hip shelf arthroplasty and Chiari osteotomy in adults. Clin Orthop Relat Res 2004; 418: 81-6. doi: 10.1097/00003086-200401000-00014. DOI: https://doi.org/10.1097/00003086-200401000-00014
Chougle A, Hemmady M V, Hodgkinson J P. Long-term survival of the acetabular component after total hip arthroplasty with cement in patients with developmental dysplasia of the hip. J Bone Joint Surg Am 2006; 88: 71-9. doi: 10.2106/JBJS.D.02689. DOI: https://doi.org/10.2106/00004623-200601000-00009
Janz V, Hipfl C, Düppers F, Perka C F, Wassilew G I. Developmental hip dysplasia treated with cementless total hip arthroplasty using a straight stem and a threaded cup: a concise follow-up, at a mean of twenty-three years. J Clin Med 2021; 10: 1912. doi: 10.3390/jcm10091912. DOI: https://doi.org/10.3390/jcm10091912
Fahlbusch H, Budin M, Volk A, Prinz F R, Linke P, Citak M, et al. Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up. Arch Orthop Trauma Surg 2023; 143: 6609-16. doi: 10.1007/s00402-023-04970-3. DOI: https://doi.org/10.1007/s00402-023-04970-3
Yacovelli S, Abdelaal M, Fillingham Y, Sutton R, Madding R, Parvizi J. Prior pelvic osteotomy affects the outcome of subsequent total hip arthroplasty. J Arthroplasty 2021; 36: 600-4. doi: 10.1016/j.arth.2020.07.080. DOI: https://doi.org/10.1016/j.arth.2020.07.080
Wells J, Millis M, Kim Y-J, Bulat E, Miller P, Matheney T. Survivorship of the Bernese periacetabular osteotomy: What factors are associated with long-term failure? Clin Orthop Relat Res 2017; 475: 396-405. DOI: 10.1007/s11999-016-4887-z. DOI: https://doi.org/10.1007/s11999-016-4887-z
Willemsen K, Doelman C J, Sam A S Y, Seevinck P R, Sakkers R J B, Weinans H, et al. Long-term outcomes of the hip shelf arthroplasty in adolescents and adults with residual hip dysplasia: a systematic review. Acta Orthop 2020; 91: 383-9. doi: 10.1080/17453674.2020.1747210. DOI: https://doi.org/10.1080/17453674.2020.1747210
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