Modified Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

Abstract

Osteonecrosis of the femoral head is a disabling condition affecting young patients and treatment of the disease in these patients is variable. We retrospectively reviewed 39 patients (43 hips) in whom a modified transtrochanteric rotational osteotomy was performed for osteonecrosis. The minimum followup was 24 months (mean, 36.6 months; range, 24-52 months). The mean patient age was 34.3 years (range, 20-51 years). Based on the ARCO classification, 17 hips were classified as Stage II and 26 as Stage III. We performed rotational osteotomy alone in 15 cases, in combination with simple bone grafting in three, and in combination with muscle-pedicle-bone grafting in 25. Sixteen of 17 ARCO Stage II cases and 24 of 26 ARCO Stage III cases had no progression of collapse or lesion size; three hips progressively collapsed. Of the 40 hips without progression the Harris hip score improved from a mean 70 to 92 points at final followup, as did the range of motion of the hip. Modified transtrochanteric rotational osteotomy is an effective method for delaying the progression of collapse in the treatment of selected cases of osteonecrosis of the femoral head.

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

“…In addition, a number of studies did not report complete data on the outcome of each hip. For example, 32 studies [3, 5, 7-9, 15, 17, 19, 23, 26, 28, 29, 33-35, 38, 40, 44-48, 52, 54-58, 60, 61, 63, 64] reported data only in terms of conversion to THA, and seven reported only in terms of progression of disease [2,4,22,30,39,42,62]. Only 15 studies reported data in terms of both conversion to THA and progression of disease [1,6,11,12,14,16,18,20,21,24,27,49,50,65,66].…”

“…Numerous procedures have been proposed to treat this condition, including core decompression [1,6,18,19,24,29,47,49,58,63], vascularized grafts [3,5,7,8,20,27,28,30,39,50,61,66], and osteotomy [2,9,16,17,23,40,44,45,62]. The term ''core decompression'' represents a spectrum of procedures that may include one large core tract or multiple small tracts [25,32].…”

Posttraumatic Osteonecrosis of the Femoral Head after Nine Years of Posterior Femoral Head Fracture Dislocation

“…7) In the described patient, the rotation involved a movement of almost 90 degrees anteriorly, and thus, the anterosuperior osteonecrosis was relocated anteroinferiorly.…”

“…Because the patient was young and active, modified transtrochanteric rotational osteotomy 7) was planned to preserve the femoral head (Fig. 3).…”

Posttraumatic Avascular Necrosis of the Femoral Head in Teenagers Treated by a Modified Transtrochanteric Rotational Osteotomy: A Report of Three Cases

“…9 We have been performing a modified transtrochanteric rotational osteotomy with good results in our center since 2003. 10 We report our experience in managing 3 cases of posttraumatic avascular necrosis of the femoral head in teenagers with a modified transtrochanteric rotational osteotomy, which has not been reported previously.…”