ABSTRACT
PURPOSE: The results of Sugioka's transtrochanteric rotational osteotomy are controversial. While many Japanese studies have reported favorable results, European and American studies have been disappointing. We present the results of Sugioka's rotational osteotomy for extensive osteonecrosis of the femoral head in young patients. METHODS AND MATERIALS: Between April. 1994 and May. 2004, Sugioka's osteotomy was performed for osteonecrosis involving a large part of the weight bearing area on 49 hips (46 patients). Of these 49 hips, 45 (43 patients) were available for follow-up. The patients were followed up for at least 2 years with an average of 52 months (range: 24-132 months). The major causes of osteonecrosis were chronic alcohol abuse in 33 hips. The mean age of the patients at the time of surgery was 31 years (range: 21-46), and the male to female ratio was 39:6. Six, 17 and 22 hips were classified as stage IIA, IIb and III using the Ficat and Alert classification, respectively. RESULTS: Thirty three of the 45 hips (74%) survived clinically and radiologically. Of these, the clinical results were excellent, good and fair in 15, 12 and 6 hips, respectively. Major complications were encountered in 12 hips [Progressive severe varus deformity in 7 hips (15%)], femur neck fracture in 3 hips (6%) and deep infection in 2 hips (4%). Among these 12 hips, seven hips (15%) required secondary THA. Five other hips (11%) were also subsequently converted to THA due to progressive collapse of the femoral head after the transtrochanteric osteotomy. CONCLUSION: Transtrochanteric osteotomy can be used to treat osteonecrosis of the femoral head in young patients with extensive necrotic lesions of the femoral head. However, Sugioka osteotomy should be used with caution due to its high incidence of complications.
Subject(s)
Female , Humans , Male , Alcoholism , Asian People , Congenital Abnormalities , Femoral Neck Fractures , Follow-Up Studies , Head , Hip , Hip Joint , Incidence , Osteonecrosis , Osteotomy , Tacrine , Weight-BearingABSTRACT
PURPOSE: This study was undertaken to investigate the relationship between the Risser sign and chronological age and menarche in elementary, middle, and high school students, and to investigate the reliability of the Risser sign. MATERIALS AND METHODS: We reviewed 1, 870 spine standing AP X-rays, which included the iliac crest. We tried to identify a correlationbetween the Risser stage and chronological age, and between Risser stage and menarche. In addition, we investigated inter-observer error in the determination of Risser stage. RESULTS AND CONCLUSION: The mean ages of Risser 1, 2, 3 and 4 female students were 12.9, 13.3, 13.6, and 14.3 years, and the mean ages of Risser 1, 2, 3 and 4 male students were 14.0, 14.3, 14.5, and 15.6 years (Spearman's rho=0.560, p<0.01). The mean menarchal age of female students were 12 years 4 months, which is 7 months earlier than the mean chronological age of Risser 1 in female students. Wefound that it takes 24 months to progress from menarche to iliac crest maturation (Risser 4) (Spearman's rho=0.571, p<0.01). The percentage of agreement in the determination of Risser stage by three orthopaedic surgeons was 73.3%, showing good reliability with a Kappa value of 0.739-0.783.