Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years

Abstract

We investigated the factors related to the radiological outcome of a transtrochanteric curved varus osteotomy in patients with osteonecrosis of the hip. We reviewed 73 hips in 62 patients with a mean follow-up of 12.4 years (5 to 31.1). There were 28 men and 34 women, with a mean age of 33.3 years (15 to 68) at the time of surgery. The 73 hips were divided into two groups according to their radiological findings: group 1 showed progression of collapse and/or joint-space narrowing; group 2 had neither progressive collapse nor joint-space narrowing. Both of these factors and the radiological outcomes were analysed by a stepwise discriminant analysis. A total of 12 hips were categorised as group 1 and 61 as group 2. Both the post-operative intact ratio and the localisation of the necrotic lesion correlated with the radiological outcome. The cut-off point of the postoperative intact ratio to prevent the progression of collapse was 33.6%, and the cut-off point to prevent both the progression of collapse and joint-space narrowing was 41.9%. The results of this study indicate that a post-operative intact ratio of 33.0% is necessary if a satisfactory outcome is to be achieved after this varus osteotomy.

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

“…Evidence has shown that small, medially located, asymptomatic lesions may be treated with observation alone, whereas the recommended options for symptomatic precollapse stage lesions are decompression 7,86-90 , osteotomy [91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] , and non-vascularized or vascularized bone-grafting 90,[109][110][111] . Once the early postcollapse stage is reached, total hip arthroplasty provides consistent results; however, satisfactory results have also been demonstrated with bone-grafting [112][113][114][115][116][117][118][119][120][121][122][123][124][125] .…”

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

“…Operative management of ONFH includes joint-salvage procedures such as proximal femoral rotational osteotomy, core decompression sequestrectomy and replacement with bone grafting, non-vascularized cancellous or cortical bone grafting of the lesion, muscle-pedicle bone grafting, free vascularized fibular grafting, and multiple small tantalum pegs [3][4][5][6][7][8][9][10][11][12]. Of these, the most commonly used procedures are core decompression combined with impaction grafting of composite bone material.…”

Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head

“…In addition, our results of TCVO were consistent with those of the previous studies on this osteotomy (Table 3). 11,14,15,17,18,19,27,28,29,30,31,32)…”

“…This osteotomy can reduce complications of conventional varus wedge osteotomy, such as elevation of the greater trochanter, nonunion of the osteotomy site, and limb length discrepancy (LLD) 9,11,12). Saito et al13) reported a 100% success rate in 4 cases of osteonecrosis of the femoral head, and the rate of satisfactory outcomes ranged from 90% to 97.3% in other studies 11,14,15)…”