Early repair of necrotic lesion of the femoral head after high-degree posterior rotational osteotomy in young patients--a study evaluated by volume measurement using magnetic resonance imaging

Abstract

We investigated the repair of femoral head necrosis with extensive necrotic lesions treated by high-degree posterior rotational osteotomy (HDPRO) in young adults and adolescents (mean age; 30.8 years) using magnetic resonance imaging (MRI). HDPRO was performed on 72 hips from 66 cases, and of those, 60 hips from 60 cases were included in this study for data analysis. All cases had extensive collapsed lesion preoperative anteroposterior radiographs. In total, 34 hips were male and 26 were females. In total, 19 had a history of steroid administration, 11 had a previous femoral neck fracture, 7 had no particular etiologic factor, and 4 had a followed slipped capital femoral epiphysis. Antero-inferior viable areas were transferred to the loaded portion below the acetabular roof by this operation. The mean posterior rotational angle was 118.5°. MRI was taken after 1 month, 6 months and 1-year post-operatively. Post-operative necrotic lesion volume compared with the preoperative necrotic lesion volume was defined as lesion volume ratio (%). The reduction of necrotic volume was observed over time, and at 1 year post-operatively, it was 19.4% for patients in their teens, 35.3% for those in twenties, 42.8% for those in their thirties and 59.5% for those in their forties. From this study, we concluded that the extensive necrotic lesions decreased in size within a short period after HDPRO in young patients.

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

“…Only one hip showed more advanced ARCO stage. Similar method was suggested in several studies as an important factor of success in TRO [ 25 , 26 ]. Our result did not support Rijnen’s findings in which 15 of 24 hips failed although the post-operative intact ratio surpassed 33% [ 27 ].…”

High-Degree Valgus Osteotomy for Severe Femoral Head Osteonecrosis After Femoral Neck Fracture with Nonunion

“…Previous reports showed that moving the viable area of the femoral head to the weight-bearing area of the acetabulum after osteotomy allows reparative blood flow into the femoral head, gradual restoration of the spherical contour of the femoral head, and reduction of the necrotic area postoperatively 17,[23][24][25][26] . If proper surgery is performed, postoperative revascularization to the femoral head occurs.…”

Complete Repair of Osteonecrosis of the Femoral Head After Basicervical Femoral Neck Rotational Osteotomy

“…The posterior rotational osteotomy, developed by Atsumi T et al, emphasizes the importance of posterior rotation of the femoral head to preserve the medial femoral circumflex vessels 12 . They found that the size of necrotic lesions decreased during the early postoperative period 13 .…”

“…In histological analysis by Sugioka et al, the necrotic areas of 2 hips were replaced by normal bone tissue after TRO 11 . Previous literature primarily used x-rays or CT scans for evaluation, with MRI evaluation being less common 13,19 . A case study reported the disappearance of a low signal area on MRI after curved intertrochanteric varus osteotomy for traumatic ONFH 19 ; however, the necrotic area was relatively small in that study.…”