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

Abstract

In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.

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

“…In addition, the area of femoral head necrosis is also a consideration. We believe it is prudent to choose this type of surgery for patients with an area of femoral head necrosis over 50% [10,28]. Of course, the presence of osteoarthritis of the hip joint is also a contraindication to this type of surgery.…”

Modified femoral neck rotational osteotomy with supercapsular approach as hip preservation surgery technique for osteonecrosis of femoral head in young patient: A case report

“…Osteotomy is a joint-preserving technique that involves shifting the weight-bearing region to the healthy part of the femoral head to reduce intraosseous venous pressure and stimulate neovascularization through surgery [ 3 ]. In the surgery for ONFH, preserving the integrity of vascular structures, especially the branches of the Medial Femoral Circumflex Artery (MFCA), is paramount in facilitating the process of bone healing and mitigating the risk of additional harm [ 4 ]. Therefore, several attempts to optimize vascularization have been developed through ideas of novel approaches.…”

A Femoral Neck Osteotomy for the Patients with Ankylosing Spondylitis and Thoracolumbar Kyphosis Combined with Hip Flexion Contracture

“…The FNO technique is reported to correct the deformity of proximal femur, such as coxa valga and varus femoral neck 5 . Femoral neck rotational osteotomy is reported to be a modified method for treating necrotic femoral heads 6 . The femoral neck lengthening osteotomy is suggested to preserve hips with Perthes and Perthes‐like deformities 7 .…”

“… 5 Femoral neck rotational osteotomy is reported to be a modified method for treating necrotic femoral heads. 6 The femoral neck lengthening osteotomy is suggested to preserve hips with Perthes and Perthes‐like deformities. 7 But they all use internal fixation to keep the osteotomy stable.…”