Curved varus femoral osteotomy for minimal dysplastic hip in patients older than 45 years of age: comparison with rotational acetabular osteotomy

Periacetabular osteotomies, such as rotational acetabular osteotomy (RAO) for osteoarthritis (OA) secondary to hip dysplasia, have produced satisfactory medium- and long-term results in early OA. However, as the degree of surgical invasion of these procedures is comparatively major and long-term postoperative rehabilitation is required, this procedure is generally not indicated for those in the fifth and sixth decades of life. Curved varus femoral osteotomy (CVO), which is a less invasive procedure, is considered a worthwhile option, although to the best of our knowledge no comparative study has been reported on these two procedures in older patients. We performed a comparative study on the outcomes of CVO for minimal dysplasia of the hip with a center-edge (CE) angle greater than 5° in 15 patients (15 joints) older than 45 years of age at a mean period of 8 years after surgery and on the outcomes of RAO in 16 patients (18 joints) performed during the same period. No significant difference was observed between the two groups regarding the Merle d'Aubigne score during follow-up. Progression of osteoarthritis was radiologically observed during follow-up in three hips in the CVO group and in one hip in the RAO group. Kaplan-Meier survivorship analysis, with radiological progression of osteoarthritis as the endpoint, predicted a survival rate of 75% at 10 years in the CVO group. In the RAO group the predicted 10-year survival rate was 94%, demonstrating no significant difference between the two groups. CVO is a less invasive surgical technique than RAO, requires a comparatively shorter period of postoperative rehabilitation, and is useful as a joint-preserving procedure in older patients with minimal dysplasia of the hip with unilateral involvement. CVO should be selected for elderly patients with a CE angle greater than 5°.