Clinical results of rotational osteotomy for treatment of avascular necrosis of the femoral head

Belal, Mo; Reichelt, A.

doi:10.1007/bf00573446

Cited by 47 publications

(20 citation statements)

References 13 publications

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“…A rotational osteotomy is another viable option because it is a joint-preserving procedure and delays the need for a potential joint arthroplasty until a later age, similar to osteochondral allograft transplantation. However, a major disadvantage is its limited success in the treatment of conditions affecting the weightbearing surface of the femoral head in young patients, and the additional challenges of conversion to a THA [5,25,28]. Conversely, osteochondral allograft transplantation has the advantage of minimal deformity of the native anatomy and will not substantially complicate subsequent THA should the need arise, as has been described for similar conditions about the knee [22].…”

Section: Discussionmentioning

confidence: 99%

Case Report: Fresh-Stored Osteochondral Allograft for Treatment of Osteochondritis Dissecans the Femoral Head

Evans

Providence

2010

Clinical Orthopaedics &Amp; Related Research

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Osteochondral defects of the femoral head are exceedingly rare, with limited treatment options. Restoration procedures for similar defects involving the knee and ankle have been well described. In this report, we present a young patient who had a symptomatic osteochondral defect of the femoral head develop secondary to trauma and underwent subsequent treatment using a fresh-stored osteochondral allograft via a trochanteric osteotomy. At the 1-year followup, the patient was symptom free with nearcomplete incorporation of the graft radiographically. Our observations in this case suggest osteoarticular implantation may be an appropriate alternative to consider when treating osteochondral defects of the femoral head.

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Section: Discussionmentioning

confidence: 99%

Case Report: Fresh-Stored Osteochondral Allograft for Treatment of Osteochondritis Dissecans the Femoral Head

Evans

Providence

2010

Clinical Orthopaedics &Amp; Related Research

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“…Possible reasons for high incidences of failure of TRO in those reports may be related to technical difficulty or improper surgical techniques including preservation of nutrient vessels, varus position of the proximal femur after osteotomy, fixation stability, and improper postoperative management [3,8,9,31,44]. Sugioka et al [42] emphasized considerable care is required during osteotomy and rotation to preserve the vascular structure of the proximal femur, but in some reports which revealed high rates of failure, postoperative vascular status of the femoral head was not described [8,9,44].…”

Section: Discussionmentioning

confidence: 99%

“…Dean and Cabanela [8] suggested early weightbearing after surgery, valgus position, and vascular compromise owing to a race-dependent difference in the anatomy of the hip capsule (ethnic origin) may have been factors in collapse of the femoral head after this procedure. Belal and Reichelt [3] considered TRO technically difficult and associated it with a high risk of late complications including progressive collapse, with failure of six of seven hips at a mean followup of 6.7 years. Rijnen et al [31] also stated the technique in Caucasian patients was more demanding for TRO owing to the different dimension of the hips and larger body size and weight of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…In another study, Koo et al [21] reported his patients experienced no additional collapse at a mean followup of 54 months. However, some studies in the American and European literature reported high failure rates for TRO [3,8,9,31,44]. Despite strict adherence to the original technique and protocol of Sugioka et al [42], Rijnen et al [31] reported conversion of 17 of 26 hips (65%) to THA during an average followup of 8.7 years.…”

Section: Introductionmentioning

confidence: 99%

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Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Biswal

Hazra

Yun

et al. 2009

Clin Orthop Relat Res

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Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

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“…However, it is considered as being major surgery that may involve prolonged recovery and limited success in the treatment of defects at the weightbearing surface [21][22][23]. In addition, THA following femoral osteotomy is challenging due to the deformed geometry, and it may entail a higher complication rate due to the previously placed hardware and deformed anatomy [23,24].…”

Section: Discussionmentioning

confidence: 99%

Fresh-stored osteochondral allografts for the treatment of femoral head defects: surgical technique and preliminary results

Kosashvili

Raz

Backstein

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to present the preliminary clinical and radiographic outcomes of the treatment of femoral head osteochondral defects in eight consecutive symptomatic patients with fresh-stored osteochondral allografts via a trochanteric osteotomy. Methods This study included all consecutive patients treated in our department between 2008 and 2010 for worsening pain and mechanical symptoms of femoral head osteochondral defects. Each patient had preoperative routine hip radiographs and a preoperative magnetic resonance imaging study that determined and recorded the defect size and femoral head diameters. Allograft donors were identified through the Multiple Organ Retrieval and Exchange program (Ontario, Canada). Results The osteochondral defects were secondary to osteochondritis dissecans in four patients, avascular necrosis in three and femoral head fracture without dislocation in one. The patients' average age at surgery was 23.7 (range 17-42), and the average follow-up was 41 months (range 24-54). Follow-up included clinical and radiographic examinations at standard intervals. The average Harris hip scores improved from 57.7 (range 50-65) points preoperatively to 83.9 (range 72-94) points at latest follow-up. Five patients had good-toexcellent clinical outcomes, and one had a fair outcome. One patient was converted to a total hip arthroplasty due to progression of arthritis. Another patient's graft subsided and he underwent a successful repeat transplantation. An additional patient required the removal of the screws transfixing her trochanter due to persistent irritation. Conclusions These findings indicate that fresh-stored osteochondral allograft transplantation using a trochanteric slide and surgical dislocation is a viable treatment option for femoral head defects in young patients.

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Clinical results of rotational osteotomy for treatment of avascular necrosis of the femoral head

Cited by 47 publications

References 13 publications

Case Report: Fresh-Stored Osteochondral Allograft for Treatment of Osteochondritis Dissecans the Femoral Head

Case Report: Fresh-Stored Osteochondral Allograft for Treatment of Osteochondritis Dissecans the Femoral Head

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Fresh-stored osteochondral allografts for the treatment of femoral head defects: surgical technique and preliminary results

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