Curved Intertrochanteric Varus Osteotomy vs Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients Under 50 Years Old

Osawa, Yusuke; Seki, Tomohiro; Okura, Toshiaki; Takegami, Yasuhiko; Ishiguro, Naoki; Hasegawa, Yukiharu

doi:10.1016/j.arth.2020.01.026

Cited by 13 publications

(16 citation statements)

References 32 publications

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“…For type A, there was little change in the stress after CVO, and the stress level was relatively lower in 0°models. This result can support the clinical repots [7,14,16,[39][40][41][42][43][44]. Therefore, it was not effective to perform the CVO with type A.…”

Section: Discussionsupporting

confidence: 61%

Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis

et al. 2021

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Background Intertrochanteric curved varus osteotomy (CVO) has been widely used to remove the necrotic bone away from the weight-bearing portion in the treatment of osteonecrosis of the femoral head (ONFH). However, whether all types of necrosis will benefit from CVO, in terms of the stress level, the effect of different center-edge (CE) angles of acetabulum on stress distribution of necrosis after CVO, and the relationship between the intact ratio and the stress of necrosis, has never been addressed. The purpose of the study was to evaluate the influence of CVO on the stress reduction in necrotic bone using a finite element analysis (FEA) with different CE angles. Methods CVO finite element models of the hip joint were simulated with a lesion of 60°. The osteotomy angles were divided into four configurations (15°, 20°, 25°, and 30°), and three types (A, B, and C1) of lesions were established based on the Japanese Investigation Committee (JIC) classification. In addition, two CE angles (18° and 33°) of acetabulum were considered. The maximum and mean von Mises stress were analyzed in terms of the necrotic bone by a physiological loading condition. Moreover, the correlation of the intact ratio measured in 3D and the stress distribution after CVO was analyzed. Results Stress reduction was obtained after CVO. For type B, the CVO angle was 20° (0.61 MPa), and for type C1, the CVO angle was 30° (0.77 MPa), if the mean stress level was close to type A (0.61 MPa), as a standard. The maximum and mean von Mises stress were higher in the CE angle of 18°models, respectively. The intact ratio measured in 3D had a good negative correlation with stress after CVO and had more influence on stress distribution in comparison to other geometric parameters. Conclusions For making decisions about the biomechanics of CVO, a CVO angle of > 20° was recommended for type B and > 30° was safe for type C1. The risk of progressive collapse was increased in the insufficient situation of the weight-bearing portion after CVO. The intact ratio could provide information about clinical outcomes and stress distribution after CVO.

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Section: Discussionsupporting

confidence: 61%

Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis

et al. 2021

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“…Considering recently reported long-term outcomes [9,24], We believe that THA should be the rst choice for treatment of ONFH. However, THA is not recommended for young people due to the risk for multiple revision surgeries in the future; surgical strategies should be carefully selected since performing the appropriate joint-preserving surgery can provide long-term functional outcomes that are equivalent to those provided by THA [25]. Additionally, preoperative mental health greatly affects satisfaction after THA; understanding the details of the cause is thus considered necessary to carefully plan the timing and appropriate surgical procedure for improved patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Risk Factors for Dissatisfaction After Total Hip Arthroplasty Among Patients With Osteonecrosis of the Femoral Head

Takemoto¹,

Seki²,

Osawa³

et al. 2020

Preprint

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Background: The objective of this study was to investigate the preoperative risk factors for dissatisfaction after total hip arthroplasty for osteonecrosis of the femoral head.Methods: A total of 71 patients (91 hips) with osteonecrosis of the femoral head who underwent total hip arthroplasty surgery in our hospital were included. The degree of satisfaction was evaluated using a visual analogue scale one year after the total hip arthroplasty. The patients were divided into two groups: the satisfied group (S group; visual analogue scale score > 20 mm) and the dissatisfied group (D group; visual analogue scale score < 20 mm). The results of the preoperative quality-of-life self-assessments, including the Short Form-36 and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, were compared between the satisfied and dissatisfied groups. Multivariate analysis was performed to examine the independent preoperative risk factors.Results: There were 49 patients (64 hips) and 22 patients (27 hips) in the S and D groups, respectively. Patient age was significantly higher in the D group, and the movement and mental scores obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and the Mental Component Summary scores of the Short Form-36 were significantly lower. However, there were no between-group differences in the pain score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and the Physical Component Summary and Role/Social Component Summary scores of the Short Form-36. Multivariate analysis showed that age and mental score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire were independent risk factors.Conclusions: Preoperative age and mental score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire strongly affected satisfaction levels observed one year after total hip arthroplasty in patients with osteonecrosis of the femoral head.

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“…They stated that with ideal patients CVO can help to maintain patients' satisfaction in the long-term follow-up. 65…”

Section: Transtrochanteric Curved Varus Osteotomymentioning

confidence: 99%

Hip preserving procedures for osteonecrosis of the femoral head after collapse

Bakırcıoğlu¹,

Atilla

2021

Journal of Clinical Orthopaedics and Trauma

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Osteonecrosis of the femoral head (ONFH) affects mainly young patients and causes secondary hip osteoarthritis if remains untreated. Several operative treatments have been introduced with successful outcomes in the early stages. However, in late stages of ONFH treatment may be challenging due to the progressive nature of disease and many surgeons prefer arthroplasty option after collapse. Considering the size, age and etiology an effort should be made to preserve hip joint selected patients with early collapse or minimal arthritic changes. The purpose of the current review is to discuss the results of joint preserving procedures for late stages of ONFH.

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Curved Intertrochanteric Varus Osteotomy vs Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients Under 50 Years Old

Cited by 13 publications

References 32 publications

Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis

Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis

Preoperative Risk Factors for Dissatisfaction After Total Hip Arthroplasty Among Patients With Osteonecrosis of the Femoral Head

Hip preserving procedures for osteonecrosis of the femoral head after collapse

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