Is minimally invasive shelf acetabuloplasty in adults more reliable than periacetabular osteotomy? Long- term results

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Philippe Chiron Remi Sylvie Nicolas Reina Louis Courtot Chiron Sylvie Courtot


This is a retrospective, single-operator study which hypothesised that shelf acetabuloplasty for acetabular dysplasia with a centre-edge angle of Wiberg between 0° and 15° and stage 1 or 2 osteoarthritis, has comparable results to periacetabular osteotomy with less severe complications. Patients and methods: 95 hips, mean follow-up of 12.8 years (4-26.4), 70.5% female (67/95), 29.5% male (28/95), mean age of 34.7 years (16-61 years). The surgical technique was minimally invasive, intermuscular between the posterior border of the tensor facia lata muscle and the anterior border of the gluteus medius muscle as described by Chiron in 2007. Survival curves were analysed using the Kaplan Meier method with the Log Rank test; Cox power test: 0.832. Results: Complications: 4 graft lyses (4.2%); 3 non-unions (3.1%); 56.8% (54/95) screw removal; no infection, no lateral femoral cutaneous nerve injury, all low-grade complications with no high-grade.

Total hip replacements: 22.1% (21/95) of which 52.3% (11/21) were in the first 5 years. Age and gender had a significant impact on survival: under 30 years, 13.9% (6/43); over 30 years, 30% (15/50); under 25 years, 0% (0/13; mean follow-up 14.6 years; 9 -26); females, 26.8% (18/67), males, 10.7% (3/28).

Survival: Overall (5 years: 90%, 10 years: 83,5%, 15 years: 77%); according to age: under 30 years (5 years: 95,3%, 10 years: 88,8%, 15 years: 84,3%), over 30 years (5 years: 84%, 10 years: 77,4%, 15 years: 69%), P-value 0.0004; according to gender: females (5 years: 86,3%, 10 years: 77,4%, 15 years: 68,9%), males (5 years: 96%, 10 years: 92,1%, 15 years: 92,1%), p-value: 0,0826; females over 30 years (5 years: 80,4%, 10 years: 75,1%, 15 years: 64,4%), females under 30 years (5 years: 91,6%, 10 years: 87,3%, 15 years: 80%), P-value: 0,1502

Survival rates were similar to those for peri acetabular arthroplasty, with no serious complications. Checking for any associated labral hip tears and arthroscopic treatment beforehand should improve the total hip replacement rate in the first 5 years.

Ideal patients are young males and those at risk are females over 30 years of age, but with results that are still acceptable for group at risk which justify this minimally invasive procedure

Keywords: Shelf arthroplasty, periacetabular osteotomy, arthroscopy, minimal invasive approach, survival curves

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CHIRON, Philippe et al. Is minimally invasive shelf acetabuloplasty in adults more reliable than periacetabular osteotomy? Long- term results. Medical Research Archives, [S.l.], v. 10, n. 11, nov. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 29 mar. 2023. doi:
Research Articles


1. Murgier J, Espie A, Bayle-Iniguez X, Cavaignac E, Chiron P. Frequency of radiographic signs of slipped capital femoral epiphysiolysis sequelae in hip arthroplasty candidates for coxarthrosis. Orthop Traumatol Surg Res. Nov 2013;99(7):791-7. doi:10.1016/j.otsr.2013.07.014
2. Wells J, Millis M, Kim YJ, Bulat E, Miller P, Matheney T. Survivorship of the Bernese Periacetabular Osteotomy: What Factors are Associated with Long-term Failure? Clin Orthop Relat Res. Feb 2017;475(2):396-405. doi:10.1007/s11999-016-4887-z
3. Heng Sharon Tan S, Tan JHI, Lim AKS, Hui JH. Periacetabular Osteotomy for Acetabular Retroversion -A Systematic Review and Meta-Analysis. Orthop Traumatol Surg Res. Sep 25 2021:103078. doi:10.1016/j.otsr.2021.103078
4. Bashti K, Navab I. Result of shelf acetabuloplasty in adults: 20 years of follow-up. Acta Med Iran. 2011;49(8):536-42.
5. Hirose S, Otsuka H, Morishima T, Sato K. Long-term outcomes of shelf acetabuloplasty for developmental dysplasia of the hip in adults: a minimum 20-year follow-up study. J Orthop Sci. Nov 2011;16(6):698-703. doi:10.1007/s00776-011-0159-7
6. 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. Jan 2004;(418):81-6. doi:10.1097/00003086-200401000-00014
7. Migaud H, Spiers A, Gougeon F, Pierchon F, Fontaine C, Duquennoy A. [Outcome of hip shelf arthroplasty in adults after a minimum of 15 years of follow-up. Long term results and analysis of failures of 56 dysplastic hips]. Rev Chir Orthop Reparatrice Appar Mot. 1995;81(8):716-23. Devenir des butees de hanche chez l'adulte apres un recul minimal de 15 ans. Resultats a long terme et analyse des echecs sur 56 hanches dysplasiques.
8. Idema WL, Nielsen HK. [Satisfactory results of shelf arthroplasty in hip dysplasia and in dysplasia with arthritis]. Ned Tijdschr Geneeskd. Jun 15 1991;135(24):1076-80. Goede resultaten van pandakplastiek wegens heupdysplasie en dysplasie met artrose.
9. KÖnig F. Osteoplastische behandlung der kongenital hüftgelenluxation. Verh Deutsch Ges Chir. 1891;20:75-80.
10. Lance M. Constitution d’une butée ostéoplastique dans les luxations et subluxations congenitales de la hanche. Presse médicale. 1925;33:922-31.
11. Kaiser G. [Plastic surgery of the acetabular roof using the Lance-Schede and Spitzy method; follow-up investigations of the patients operated on in the orthopedic clinic of the University of Leipzig between the years 1930 and 1952]. Ergeb Chir Orthop. 1958;41:50-91. Die Pfannendachplastik nach der Methode Lance-Schede und Spitzy; Nachuntersuchungsergebnisse der an der Orthopadischen Universitatsklinik Leipzig in den Jahren 1930 bis 1952 operierten Patienten.
12. Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. Jan 1949;31A(1):40-6.
13. Chiron P, Laffosse JM, Bonnevialle N. Shelf arthroplasty by minimal invasive surgery: technique and results of 76 cases. Hip Int. 2007;17 Suppl 5:S72-82.
14. Girard J, Springer K, Bocquet D, Cotten A, Duquennoy A, Migaud H. Influence of labral tears on the outcome of acetabular augmentation procedures in adult dysplastic hips. Prospective assessment with a minimum follow-up of 12 years. Acta Orthop Belg. Feb 2007;73(1):38-43.
15. Berton C, Bocquet D, Krantz N, Cotten A, Migaud H, Girard J. Shelf arthroplasties long-term outcome: influence of labral tears. A prospective study at a minimal 16 years' follows up. Orthop Traumatol Surg Res. Nov 2010;96(7):753-9. doi:10.1016/j.otsr.2010.05.005
16. Uchida S, Hatakeyama A, Kanezaki S, et al. Endoscopic shelf acetabuloplasty can improve clinical outcomes and achieve return to sports-related activity in active patients with hip dysplasia. Knee Surg Sports Traumatol Arthrosc. Oct 2018;26(10):3165-3177. doi:10.1007/s00167-017-4787-0
17. Uchida S, Murata Y, Tsukamoto M, et al. Endoscopic Shelf Acetabuloplasty Concomitant With Labral Repair, Cam Osteoplasty, and Capsular Plication to Treat Acetabular Dysplasia in Artistic Athletes: A Case Series. Orthop J Sports Med. Nov 2021;9(11):23259671211049222. doi:10.1177/23259671211049222
18. Uchida S, Wada T, Sakoda S, et al. Endoscopic shelf acetabuloplasty combined with labral repair, cam osteochondroplasty, and capsular plication for treating developmental hip dysplasia. Arthrosc Tech. Feb 2014;3(1):e185-91. doi:10.1016/j.eats.2013.09.013
19. Severyns M, Andeol Q, Flurin L, et al. Three-Dimensional Navigation (O-arm) for Minimally Invasive Shelf Acetabuloplasty. Arthrosc Tech. Aug 2020;9(8):e1067-e1071. doi:10.1016/j.eats.2020.04.002
20. Kamachi Y, Kinoshita K, Sakamoto T, Matsunaga T, Yamamoto T. Bone union status of all osteotomy sites one year after curved periacetabular osteotomy based on computed tomography. Orthop Traumatol Surg Res. May 1 2021:102955. doi:10.1016/j.otsr.2021.102955
21. Fawzy E, Mandellos G, De Steiger R, McLardy-Smith P, Benson MK, Murray D. Is there a place for shelf acetabuloplasty in the management of adult acetabular dysplasia? A survivorship study. J Bone Joint Surg Br. Sep 2005;87(9):1197-202. doi:10.1302/0301-620X.87B9.15884
22. Hamanishi C, Tanaka S, Yamamuro T. The Spitzy shelf operation for the dysplastic hip. Retrospective 10 (5-25) year study of 124 cases. Acta Orthop Scand. Jun 1992;63(3):273-7. doi:10.3109/17453679209154781
23. Love BR, Stevens PM, Williams PF. A long-term review of shelf arthroplasty. J Bone Joint Surg Br. Aug 1980;62(3):321-5. doi:10.1302/0301-620X.62B3.7410463
24. Stetzelberger VM, Leibold CS, Steppacher SD, Schwab JM, Siebenrock KA, Tannast M. The Acetabular Wall Index Is Associated with Long-term Conversion to THA after PAO. Clin Orthop Relat Res. May 1 2021;479(5):1052-1065. doi:10.1097/CORR.0000000000001641
25. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. Jul 2008;466(7):1633-44. doi:10.1007/s11999-008-0242-3
26. Lerch TD, Steppacher SD, Liechti EF, Siebenrock KA, Tannast M. [Bernese periacetabular osteotomy. : Indications, technique and results 30 years after the first description]. Orthopade. Aug 2016;45(8):687-94. Periazetabulare Osteotomie nach Ganz : Indikationen, Technik und Ergebnisse 30 Jahre nach Erstbeschreibung. doi:10.1007/s00132-016-3265-6
27. Ahmad SS, Giebel GM, Perka C, et al. Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis. Hip Int. Sep 27 2021:11207000211048425. doi:10.1177/11207000211048425
28. 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. Int Orthop. May 2022;46(5):989-997. doi:10.1007/s00264-022-05322-3
29. Osawa Y, Hasegawa Y, Seki T, Amano T, Higuchi Y, Ishiguro N. Significantly Poor Outcomes of Total Hip Arthroplasty After Failed Periacetabular Osteotomy. J Arthroplasty. Sep 2016;31(9):1904-9. doi:10.1016/j.arth.2016.02.056
30. Osawa Y, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N. Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy. J Orthop Sci. Mar 2018;23(2):346-349. doi:10.1016/j.jos.2017.11.001