Posterior rotational osteotomy for the treatment of femoral head osteonecrosis

Abstract

Posterior rotational osteotomy in 46 hips of 39 patients with femoral head osteonecrosis was reviewed radiographically and clinically after 2-12 years of follow-up (mean 5 years). The age of the patients at the time of surgery ranged from 18 to 60 years, with a mean of 35 years. There were 18 women and 21 men. The cause of the osteonecrosis was steroid administration in 14, alcohol abuse in 5, trauma in 16, and no apparent risk factor in 4. According to the Ficat staging system, 2 hips were stage II, 30 hips III, and 14 hips stage IV. All hips had an extensive lesion. Forty-one hips showed less than 1/3 noncollapsed posterior living area, which was a contraindication for traditional anterior rotational osteotomy. The posterior rotational angle was 60-180 deg with an mean of 127 deg. Recollapse of the final follow-up anteroposterior radiograph was prevented in 36 hips (78%). Progressive joint space narrowing was found in 12 hips (26%). Of these hips, 9 suffered recollapse, while the remaining 3 hips did not. Clinically, 32 hips (70%) showed excellent or good results (both hips in stage II, 23 of 30 hips in stage III, 7 of 14 hips in stage IV. A fair or poor result was seen in 14 hips (30%)). These results suggest that posterior rotational osteotomy is effective in delaying the progression of degeneration for large necrotic lesions, especially in young patients. Extent of rotation is limited to 150 deg because of limitations of bone quality. The indications should be refined further, and longer term follow-up is necessary.

Early repair of necrotic lesion of the femoral head after high-degree posterior rotational osteotomy in young patients--a study evaluated by volume measurement using magnetic resonance imaging

“…In addition, the viable region of the head constantly bears weight, resulting in the reduction of pressure on the collapsed necrotic lesion. The results of HDPRO for extensive femoral head osteonecrosis are excellent [ 14–18 ], but because it is technically demanding, in reality it is hardly widely used [ 19 ].…”

“…Atsumi et al . [ 14–19 ] have performed high-degree posterior rotational osteotomy (HDPRO) for young patients who were not indicated for anterior rotational osteotomy or varus osteotomy because of their extensive necrotic areas. The concept of HDPRO is that after posterior rotation, the posterior column artery moves medially and is relaxed; therefore, tension does not occur, and because the vascular supply of the head can easily be preserved, HDPRO becomes possible [ 15 ].…”

“…Atsumi et al . [ 14–19 ] reported good results even in cases with large necrosis and prominent collapse, which ware not indicated for anterior rotational osteotomy or varus osteotomy.…”

Risk factor analysis for postoperative complications requiring revision surgery after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head

“…Anterior rotational osteotomy was performed when necrosis was localized to the anterior portion of the femoral head [ 6 ], and posterior rotational osteotomy was performed when there was necrosis in the middle and posterior portions of the femoral head [ 7 , 8 ]. The surgical technique used was essentially the same as the originally described technique [ 6 ].…”

“…In 1978, Sugioka proposed transtrochanteric rotational osteotomy (TRO) as a joint-preserving procedure for the treatment of ONFH [ 6 ]. This procedure leads to excellent clinical outcomes if patients are appropriately selected, the procedure is accurately performed, and appropriate postoperative rehabilitation is provided [ 7 – 13 ]. However, postoperative complications that require revision surgery after TRO may result in poor clinical outcomes.…”