Dear Panayot

The Chiari osteotomy is a surgery salvation in adolescents because the patient is too young for THR. In adults I prefer performing THR because I believe the Chiari osteotomy besides being a high morbidity surgery, with a lot of complications, would not solve the problem of the patient.

Dear Nelson,

There are some young adults with dysplastic coxarthritis who are too young for THR. In this group of patients the Chiari osteotomy gives very good results. The explanation lies in the medialization of the rotation center of the hip joint which increases the outer lever bringing benefit to the loading of the joint. In my practice I have a good experience with this tactics postponing THR for a later age. In the early 50's Friedrich Chiari recommended the pelvic osteotomy even in 60-agers with good results. Of course this was before the THR era.

I also agree that is a very morbid procedure and that last for a few years. In patients that the head of the femur can be reduced by abduction and internal rotation the way to go is to performa a Ganz osteotomy that will provide a better bone stock for a THR years latter