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

Abstract

BackgroundThis study investigated the risk factors for postoperative complications requiring revision surgery within 3 years after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).MethodsWe reviewed 127 patients (147 hips) who underwent TRO (anterior or posterior rotational osteotomy) for ONFH between January 2002 and December 2014. Two patients were lost to follow-up, and five patients with progression of femoral head collapse requiring a salvage procedure such as total hip arthroplasty within 3 years after TRO were excluded. The better hip in patients treated bilaterally was also excluded (n = 20) to avoid duplication of patient demographics, leaving 120 hips (120 patients) for the analysis. We reviewed the medical records of each patient to screen for postoperative complications that required revision surgery within 3 years after surgery, recording the patient’s age, sex, body mass index, surgical side, condition of the contralateral hip, previous alcohol intake, previous alcohol abuse, previous corticosteroid use, perioperative corticosteroid use, smoking status, preoperative stage and type of ONFH, preoperative activity level, and preoperative and final follow-up Japanese Orthopaedic Association scores. Differences between cases with and without complications were analyzed.ResultsEleven (9.2%) cases showed postoperative complications that required revision surgery. The most common complication was deep infection (n = 5), followed by nonunion of the greater trochanter (n = 3), nonunion of the intertrochanteric osteotomy site (n = 2), and femoral head fracture (n = 1). The multivariate analysis showed an independent association between previous alcohol abuse and postoperative complications (odds ratio, 13.5).ConclusionA correlation might exist between alcohol abuse and complications following a TRO procedure.

A Pilot Experiment to Measure the Initial Mechanical Stability of the Femoral Head Implant in a Cadaveric Model of Osteonecrosis of Femoral Head Involving up to 50% of the Remaining Femoral Head

“…Still, however, little is known about the risk factors associated with its pathogenesis and pathophysiology, although they include the long-term use of chronic steroids, smoking, alcoholism, hip trauma and prior hip surgery [ 11 , 12 ]. This makes it difficult to define surgical methods and curative effects [ 1 , 13 ]. It is, therefore, crucial to obtain a better understanding of the pathogenesis of and make therapeutic approaches to ONFH [ 8 ].…”

“…Despite recent advancements in diagnostic modalities, effective treatments have been elusive and a majority of cases of ONFH eventually result in a collapse of the femoral head. Most of the surgical modalities for patients with ONFH aim to prevent the collapse of the subchondral bone, although their clinical outcomes have been reported to be inconsistent [ 1 , 13 ]. Core decompression may be effective for the treatment of early-stage ONFH, although femoral osteotomy, vascularized or non-vascularized bone grafting and total hip arthroplasty (THA) may also be attempted for that of advanced ONFH [ 14 ].…”

Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions

“…Hip preservation surgery is preferred but remains a challenge for young patients with avascular necrosis of the femoral head (AVN). The survival rate of the femoral head decreases with increased size, advanced stage and lateralization of the necrotic lesion [ 1 , 2 ]. Several osteotomies have been introduced for treating large lesions with type C according to Japanese investigation committee (JIC) classification [ 3 ].…”

Early efficacy of rotational osteotomy of the femoral neck with preservation of the round ligament in the treatment of osteonecrosis of the femoral head

“…Schneider et al [11] performed a systematic analysis of each osteotomy and con rmed the e cacy of the abovementioned procedures, but with signi cant differences in success rates. Only exion osteotomy achieved the desired results, with 5-and 10-year hip survival rates of 89.2 and 60.7%, respectively, and intertrochanteric rotational osteotomy had a low success rate and a high complication rate [4,11]. Considering that the low success rate of intertrochanteric rotational osteotomy may be related to injury to the medial circum ex femoral artery (MFCA) [12], Professor Ganz described a surgical technique for hip dislocation based on a detailed anatomical study of the blood supply to the femoral head, which was resulted in no complications such as ischemic necrosis when applied in the treatment of hip disorders [13].…”

“…Therefore, hip-preserving treatment for young patients has become a hot research topic in recent years. In particular, various osteotomies are most prevalent in Asia [4][5][6]. These osteotomies include transtrochanteric curved varus osteotomy (TCVO), transtrochanteric rotational osteotomy (TRO), and rotational osteotomy at the base of the femur [7][8][9][10].…”