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

BACKGROUND: Various osteotomies have been introduced to treat osteonecrosis of the femoral head. The purpose of this study was to compare surgical parameters, postoperative limb length discrepancy, and minimum 5-year clinical and radiological results between transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head. METHODS: From 2004 to 2009, 103 consecutive TROs (97 patients) followed by 72 consecutive TCVOs (64 patients) were performed for the treatment of osteonecrosis of the femoral head. Of these, 85 patients (91 hips) in the TRO group and 58 patients (65 hips) in the TCVO group completed minimum 5-year clinical and radiological follow-up. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: The TCVO group had shorter operation time (p < 0.05) and less estimated blood loss (p = 0.026). Postoperative collapse developed in 26 hips (28.6%) in the TRO group and 7 hips (10.8%) in the TCVO group (p = 0.007). Osteophyte formation was observed in 34 hips (37.4%) in the TRO group and 13 hips (20%) in the TCVO group (p = 0.020). Fifteen hips (16.5%) in the TRO group and 7 hips (10.8%) in the TCVO group underwent conversion total hip arthroplasty (THA). The survival rate at 9 years with radiographic collapse as the endpoint was 68.7% (95% confidence interval [CI], 58.1% to 79.3%) in the TRO group, and 84.7% (95% CI, 71.5% to 97.9%) in the TCVO group. With conversion to THA as the endpoint, the survival rate was 82.2% (95% CI, 73.1% to 91.3%) in the TRO group and 89.2% (95% CI, 81.7% to 96.7%) in the TCVO group. CONCLUSIONS: The comparison indicates that TCVO was better than TRO in terms of surgical parameters including operation time and estimated blood loss while the 9-year survival rates were similar.

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

Posttraumatic osteonecrosis of the femoral head (ONFH) is the most serious complication after fracture dislocation of the femoral head. The rate of this complication was reported to range from 1.7% to 40%. Although the development of posttraumatic osteonecrosis normally occurs within 2 years of injury, there are some reports of the late development ONFH. The authors encountered a case of posttraumatic ONFH that developed after 9 years of a Pipkin type I fracture dislocation. The patient was treated by modified transtrochanteric rotational osteotomy. We report this rare case with a review of the relevant literatures.

Comparison of the Results of Core Decompression and Sugioka's Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: This study conducted a comparative analysis on 49 hips treated with a core decompression procedure and 19 hips treated with a Sugioka's transtrochanteric rotational osteotomy for a osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: This study evaluated the relationship between the Ficat and Arlet Stage and the extent of the necrotic lesion (using Shimizu's Grade Classification), and the clinical outcome of each procedure. The patient's outcomes were assessed after a mean follow-up of 46 months (range=36-82 months) after the core decompression and 53 months (range=37-108 months) after the Sugioka's transtrochanteric rotational osteotomy. The results were considered successful if the patients were asymptomatic with no disease progression, and unsuccessful if there was radiographic (progression of the stage or collapse) or clinical failure (the need for an arthroplasty or subsequent salvage operation). RESULTS: Twenty one out of 49 cases (43%) in the core decompression group and 14 out of 19 (74%) in the rotational osteotomy group showed successful outcomes. In the core decompression group, among the 22 F-A Stage I hips, 15 (68%) hips had survived according to radiological criteria. All four (100%) Shimizu's Grade A hips of the F-A Stage I had successful results, which is in contrast to the 11 hips out of 18 hips (61%) of the Shimizu's Grade B and C hips (p<0.01). Six (38%) out of 16 F-A Stage IIA hips and two (25%) out of eight IIB hips in the core decompression group had successful results, while 11 (85%) out of 13 IIA and two (50%) out of four stage IIB hips in the rotational osteotomy group had successful results. In the F-A Stage III hips, all 2 hips in the Sugioka transtrochanteric rotational osteotomy treatment group had survived, while none of the three Shimizu's Grade C hips in the core decompression group were successful. CONCLUSION: A core decompression is effective only in the earliest stages of osteonecrosis (F-A Stage I), which means that its success strongly depends on the location and extent of the femoral head necrosis. Sugioka's transtrochanteric rotational osteotomy is a more dependable procedure than a core decompression for treating large lesions of nonsteroidal ONFH, particularly for patients under the age of 50.

Clinical Results of Transtrochanteric Rotational Osteotomy for Nontraumatic Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

Since 1983, the transtrochanteric rotational osteotomy has been performed in 38 hips of 36 patients for the nontraumatic avascular necrosis of the femoral head at the department of orthopaedic surgery of Seoul National University Hospital. Out of them, 26 hips(18 cases of Sugioka grade I and 8 cases of Sugioka grade II ) were followed up for more than 1 year. The average period of follow-up was 3 years and 5 months(range, 1 year and 2 months to 7 years). These cases include 3 cases of failure before 2 years after operation. Overall, the result was satisfactory in 20 cases(77%)out of a total of 26 cases(success in 18 cases(69%)and good in 2 cases(8%)). The results of the grade I lesions(14 cases of success and 1 case of good result out of 18 cases) were better than those of the grade I lesions(4 cases of success and 1 case of good result out of 8 cases). Complications occurred in 5 cases. These include an ectopic ossification, a stress fracture of the neck, a nonunion of the osteotomy site, a nonunion of the greater trochanter and a delayed union of the greater trochanter. There were 6 cases of failure. For the 4 cases of them, hip replacement arthroplasy was performed. The MRI images axial to the longitudinal axis of the femoral neck gave excellent information for the operation.