Posterior Rotational Osteotomy for Nontraumatic Osteonecrosis with Extensive Collapsed Lesions in Young Patients

Atsumi, Takashi; Kajiwara, Toshihisa; Hiranuma, Y.; Tamaoki, Sachio; Asakura, Yasuhiro

doi:10.2106/jbjs.f.00767

Cited by 27 publications

(17 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The success of the osteotomy is closely related to the extent and location of the necrotic lesions. [2][3][4][5][6][7]10,[12][13][14][15][16][17] Zhao et al,7 in a study evaluating 73 hips in 62 patients treated with a transtrochanteric curved varus osteotomy, reported that the cutoff point of the post-operative intact ratio to prevent the progression of collapse was 33.6%, and that the cut-off point to prevent both the progression of collapse and joint-space narrowing was 41.9%. In our study, post-operative LHI and the location of the lesion were significant factors for determining the progression of collapse or joint space narrowing.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Ito

Tanino

Yamanaka

et al. 2012

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported successful results with this technique. 10,14,15 However, this osteotomy has been described as technically demanding. 16,17 The varus osteotomy is less invasive and less technically demanding than the transtrochanteric rotational osteotomy.…”

Section: Discussionmentioning

confidence: 99%

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

Ito

Tanino

Yamanaka

et al. 2012

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

show abstract

“…Results of studies of osteotomy vary according to different types of osteotomy. Transtrochanteric anterior rotational osteotomy has showed good results but was technically demanding [62]. Varus osteotomy aims to relocate the necrotic bone medially and shift the intact lateral articular surface into the weight bearing position.…”

Section: Surgical Treatment Of Avnmentioning

confidence: 99%

Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management

Chan¹,

Mok²

2012

TOORTHJ

110

112

View full text Add to dashboard Cite

Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease. Currently, there is no consensus on whether universal screening of asymptomatic AVN should be performed for long-term glucocorticoid users. A high index of suspicion should be exhibited for bone and joint pain at typical sites. Magnetic resonance imaging (MRI) or bone scintigraphy is more sensitive than plain radiograph for diagnosing early-stage AVN. Conservative management of AVN includes rest and reduction of weight bearing. Minimization of glucocorticoid dose or a complete withdrawal of the drug should be considered if the underlying conditions allow. The efficacy of bisphosphonates in reducing the rate of collapse of femoral head in AVN is controversial. Surgical therapy of AVN includes core decompression, osteotomy, bone grafting and joint replacement. Recent advances in the treatment of AVN include the use of tantalum rod and the development of more wear resistant bearing surface in hip arthroplasty.

show abstract

“…Atsumi et al ,79 have (2006) observed that many young patients have extensive lesions with advanced collapse that would not be candidates for the procedure of Sugioka procedure. For these patients, from the remaining anterior area of living femoral head, bone can be moved to the loaded lateral portion of the joint with use of a posterior rotational osteotomy.…”

Section: Osteotomiesmentioning

confidence: 99%

Management of avascular necrosis of femoral head at pre-collapse stage

Sen¹

2009

Indian J Orthop

108

View full text Add to dashboard Cite

In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efficacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufficient, to support their routine use in the treatment or prevention of osteonecrosis of the hip. Core decompression with modification of technique is still one of the safest and most commonly employed procedures with evidence based success in the pre-collapse stage of AVN of femoral head. The additional use of bone morphogenic protein, and bone marrow stem cells may provide the opportunity to enhance the results of core decompression. At present, the use of large vascularised cortical grafts, the other surgical procedure with high success rate is still not common due to technical difficulty in surgery. Likewise osteotomies are also not getting common as arthroplasty is getting more acceptable, so is awaited without any intermediate big surgical interventions.

show abstract

Posterior Rotational Osteotomy for Nontraumatic Osteonecrosis with Extensive Collapsed Lesions in Young Patients

Abstract: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Cited by 27 publications

References 11 publications

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

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

Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management

Management of avascular necrosis of femoral head at pre-collapse stage

Contact Info

Product

Resources

About