Joint Preservation of Severe Osteonecrosis of the Femoral Head Treated by Posterior Rotational Osteotomy in Young Patients: More Than 3 Years of Follow-up and Its Remodeling

Atsumi, Takashi; Hiranuma, Y.; Tamaoki, Sachio; Nakamura, Kentaro; Asakura, Yasuhiro; Nakanishi, Ryosuke; Katoh, Eiji; Watanabe, Minoru; Kajiwara, Toshihisa

doi:10.1007/978-4-431-38200-3_11

Cited by 2 publications

(4 citation statements)

References 7 publications

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“…HDPRO is a surgical technique that is effective for cases with an extensive necrotic lesion, which has spread both anteriorly and posteriorly, and has not been indicated for anterior rotation [ 18 ]. Anterior rotational osteotomy has been reported to create instability because of the collapsed necrotic lesion that has migrated anteriorly post-operatively [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…In daily activities the hip joint is mainly in the flexed position, resulting in the femoral head remaining constantly stable [ 16 ]. For these reasons, HDPRO is thought to create an environment in which the weight could be dispersed and stabilized, leading to the repair of the necrotic lesion [ 18 ]. In this study, in cases with extensive osteonecrosis as well as advanced head collapse, HDPRO was performed and the repair of necrotic lesions was subsequently observed at an early stage on MRI images.…”

Section: Discussionmentioning

confidence: 99%

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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

Ishikwa

Atsumi

Tamaoki

et al. 2015

Journal of Hip Preservation Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Ishikwa

Atsumi

Tamaoki

et al. 2015

Journal of Hip Preservation Surgery

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“…This was confirmed radiographically. 18,21 The theoretical advantages of posterior rotational osteotomy were born out by the results obtained in 28 patients with advanced stage of osteonecrosis who underwent this procedure and were followed up for between 3 and 17 years. 21 The main cause of failure was due to an insufficient amount of intact articular surface being transposed into the weight-bearing region of the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

“…Cases where more than one-third of the anterior and posterior aspects of the femoral head remain noncollapsed. 18,20,21 Preoperative Assessment Preoperative assessment depends heavily on a careful evaluation of anteroposterior and lateral radiographs, at times supplemented by magnetic resonance imaging. AP views are taken with the patient in a supine position.…”

Section: Indicationsmentioning

confidence: 99%

Proximal Femoral Osteotomies

Atsumi¹,

Hosalkar²

2008

Techniques in Orthopaedics

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A number of proximal femoral osteotomies have been described to treat patients with moderately advanced stages of osteonecrosis of the femoral head. These include varus or valgus, flexion or extension, and anterior or posterior rotation. The goal of all is to move the diseased and often collapsed segment of the femoral head out of the superior region of primary weight bearing, and to replace it with a relatively intact and viable portion of the femoral head. These procedures are technically difficult, have limited indications, require meticulous preoperative planning, and involve prolonged postoperative care. They have been done infrequently in the United States, but more commonly in other areas of the world. Reported results have varied considerably. However, in certain centers with the greatest experience, satisfactory results have been achieved in a high percentage of patients. Proximal femoral osteotomies may be indicated in selected patients with advanced stages of osteonecrosis in whom our goal is to delay or prevent the need for total hip replacement or other arthroplasties. Key Words: osteonecrosis-posterior rotational osteotomyanterior rotational osteotomy-intertrochanteric osteotomy-avascular necrosis.

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Joint Preservation of Severe Osteonecrosis of the Femoral Head Treated by Posterior Rotational Osteotomy in Young Patients: More Than 3 Years of Follow-up and Its Remodeling

Cited by 2 publications

References 7 publications

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

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

Proximal Femoral Osteotomies

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