Long-term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head

Abstract

We have previously described the mid- to long-term results of conventional simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head, showing that 19 of the 26 hips had good or excellent results. We extended the follow-up to a mean of 18.1 years (10.5 to 26) including a total of 34 hips in 28 patients, with a mean age at surgery of 33 years (19 to 53). There were 18 men and ten women and 25 hips (74%) had a satisfactory result with a Harris hip score ≥ 80. In all, six hips needed total hip replacement (THR) or hemiarthroplasty. The collapse of the femoral head or narrowing of the joint space was found to have progressed in nine hips (26%). Leg shortening after osteotomy was a mean of 19 mm (8 to 36). With conversion to THR or hemiarthroplasty as the endpoint, the ten-year survival rate was 88.2% (95% confidence interval (CI) 82.7 to 93.7) and the 20-year survival rate was 79.7% (95% CI 72.1 to 87.3); four hips were converted at ten years and other two hips were converted at 20 years. Shortening of the leg after osteotomy remains a concern; however, the conventional varus half-wedge osteotomy provides favourable long-term results in hips with less than two-thirds of the medial part of the femoral head affected by necrotic bone and with normal bone superolaterally.

Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip

“…Risk of neurovascular injury and abductor weakness was comparable to previous reports of femoral shortening for DDH [10,11,25,26]. In general, it was considered a favourable surgical procedure for treatment of CROWE IV DDH.…”

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

“…Evidence has shown that small, medially located, asymptomatic lesions may be treated with observation alone, whereas the recommended options for symptomatic precollapse stage lesions are decompression 7,86-90 , osteotomy [91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] , and non-vascularized or vascularized bone-grafting 90,[109][110][111] . Once the early postcollapse stage is reached, total hip arthroplasty provides consistent results; however, satisfactory results have also been demonstrated with bone-grafting [112][113][114][115][116][117][118][119][120][121][122][123][124][125] .…”

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

“…Operative management of ONFH includes joint-salvage procedures such as proximal femoral rotational osteotomy, core decompression sequestrectomy and replacement with bone grafting, non-vascularized cancellous or cortical bone grafting of the lesion, muscle-pedicle bone grafting, free vascularized fibular grafting, and multiple small tantalum pegs [3][4][5][6][7][8][9][10][11][12]. Of these, the most commonly used procedures are core decompression combined with impaction grafting of composite bone material.…”