Osteotomy as a treatment for bilateral osteoarthritis of the hip is controversial because of deterioration of the contralateral side. We tried to not cause the contralateral hip to deteriorate even more while curing osteoarthritis by simple methods (release of iliopsoas and adductor longus muscle tendons and lateral transfer of the greater trochanter; Maquet's operation) during the rehabilitation period of Pauwels' valgus osteotomy.
Eighteen patients (17 women, 1 man; mean age, 49 years) were indicated for bilateral operations performed simultaneously from 1984 to 2001 and followed for more than 3 years (mean, 105 months; range, 36-188 months). They were analyzed clinically (hip score of Hospital for Special Surgery) and radiographically. Pauwels' valgus osteotomy was indicated for 18 hips with or without additional operations. Maquet's operation was performed simultaneously on all contralateral sides. Three weeks after the operations, the Maquet's operation side was fully weight-bearing and the other side was under controlled weight-bearing for 1 year.
The mean hip score of the valgus osteotomy side was 36 points before the operation and 73 points at the final follow-up, respectively; that of Maquet's operation side was 44 and 77 points, respectively. Two-thirds (24 of 36) of the hips maintained more than 70 points of hip score at the final follow-up. Four hips were converted to total hip arthroplasty. Kaplan-Meier survivorship analysis revealed that the congruous joint maintained its joint space width for 10 years.
Bilateral simultaneous femoral osteotomies for the late stages of osteoarthritis could be an alternative to bilateral total hip arthroplasties.