Characteristics of the articular cartilage formed after intertrochanteric osteotomy. A case report.

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Abstract
Narrowing of the joint space is frequently seen on radiographs of osteoarthrotic hips. After intertrochanteric osteotomy is performed for the treatment of osteoarthrosis, an increase in the joint space is sometimes observed on serial radiographs, suggesting that the formation of reparative tissue or the regeneration of articular cartilage, or both, may occur after osteotomy. However, little information is available on the histopathological characteristics of the reparative tissue formed after osteotomy. The proximal part of the femur and the acetabulum were retrieved at autopsy from a patient who had had a successful intertrochanteric osteotomy twenty-four years earlier. The retrieval of the specimen provided a unique opportunity both for histological examination of the reparative tissue and for comparison of the histological findings with the radiographic changes. Although there has been controversy with regard to the percentage and the duration of good results after an intertrochanteric osteotomy of the hip in adults who have osteoarthrosis [1-9], the case of this patient is an excellent example of restoration and prolonged successful function of the hip joint. A sixty-six-year-old woman was first seen in 1965 because of pain in the left hip that had begun after two minor falls. The pain was diagnosed as being due to degenerative osteoarthrosis. Five years earlier, in 1960, the patient had had osteoarthrosis in the right hip and a Moore prosthesis had been inserted. Radiographs made at the time had revealed complete loss of the articular cartilage of the left hip medially but preservation of the cartilage laterally. Although not pathognomonic, this configuration can be associated with the presence of an intra-acetabular labrum [2]. In 1962, radiographs again demonstrated the loss of the articular cartilage medially, as well as juxta-articular cysts on both sides of the joint Figure 1. By 1965, the degenerative changes had progressed, with enlargement of the cysts, an increase in subchondral hypertrophy, and deformation of the femoral head, although the lateral joint space had persisted Figure 2. The patient chose not to have a cup arthroplasty because of the rehabilitation that it would have necessitated. Because total hip replacements were not being performed in the United States at that time, an intertrochanteric osteotomy was done in October 1966, despite the extensive cartilaginous destruction, the deformation of the femoral head, and the cysts on both sides of the joint. The osteotomy was performed with medial displacement of the femoral shaft and with the use of a McLaughlin pin and side-plate for internal fixation. There were no complications. A radiograph, made six months postoperatively, showed an increase in the joint space and some improvement in the contours of the joint Figure 3. In September 1969, the patient returned to Britain, the Moore prosthesis was removed, and a total replacement of the right hip was performed by Sir John Charnley. Radiographs made in 1970 showed union of the osteotomy of the left hip and a further increase in the joint space. In February 1970, the range of motion of the left hip consisted of 0 to 120 degrees of flexion, 10 degrees of abduction, 15 degrees of external rotation and extension, and 0 degrees of internal rotation and extension. The Trendelenburg test was negative. The patient used no support, and she had no pain on the left side.

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