Result of Sugioka's Transtrochanteric Osteotomy for Osteonecrosis of Femoral Head

Abstract

Purpose:The results of Sugioka's transtrochanteric rotational osteotomy are controversial. While many Japanese studies have reported favorable results, European and American studies have been disappointing. We present the results of Sugioka's rotational osteotomy for extensive osteonecrosis of the femoral head in young patients. Methods and Materials: Between April. 1994 and May. 2004, Sugioka's osteotomy was performed for osteonecrosis involving a large part of the weight bearing area on 49 hips (46 patients). Of these 49 hips, 45 (43 patients) were available for follow-up. The patients were followed up for at least 2 years with an average of 52 months (range: 24-132 months). The major causes of osteonecrosis were chronic alcohol abuse in 33 hips. The mean age of the patients at the time of surgery was 31 years (range: 21-46), and the male to female ratio was 39:6. Six, 17 and 22 hips were classified as stage IIA, IIb and III using the Ficat and Alert classification, respectively. Results: Thirty three of the 45 hips (74%) survived clinically and radiologically. Of these, the clinical results were excellent, good and fair in 15, 12 and 6 hips, respectively. Major complications were encountered in 12 hips [Progressive severe varus deformity in 7 hips (15%)], femur neck fracture in 3 hips (6%) and deep infection in 2 hips (4%). Among these 12 hips, seven hips (15%) required secondary THA. Five other hips (11%) were also subsequently converted to THA due to progressive collapse of the femoral head after the transtrochanteric osteotomy. Conclusion: Transtrochanteric osteotomy can be used to treat osteonecrosis of the femoral head in young patients with extensive necrotic lesions of the femoral head. However, Sugioka osteotomy should be used with caution due to its high incidence of complications.

Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

“…As the recent studies suggesting that stem cells can heal necrotic tissue are being conducted, an attempt was made to create the regeneration of the femoral head by performing bone marrow transplantation on the osteonecrosis of the femoral head [13]. In the results of analyzing the bone marrow from patients with osteonecrosis of the femoral head due to steroids, the hypothesis that osteonecrosis of the femoral head is a disease derived from mesenchymal stem cells, since the activity of FCFUs (fibroblast colony-forming units), reflecting interstitial cells, were decreased [6], given problems wherein previous femoral head conservative surgery led to many different results, and given that it is a difficult surgical procedure with a high morbidity rate on the donor site support such an attempt [2,17,19,20].…”

Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

“…(Fig. 1) 27) , 기존의 대퇴 골두 보존술은 그 결 과가 다양한 점, 술기가 어렵다는 점, 그리고 공여부의 이환 율이 높다는 문제점이 이러한 시도를 뒷받침하고 있다 [15][16][17][18] . 골수 이식술의 효과를 설명할 수 있는 다른 이론은 주입 한 골수 세포가 혈관생성을 촉진하는 사이토카인을 분비함 으로써 결과적으로 혈관 생성을 증가시켜 괴사부분에 골형 성을 유발한다는 것이다 19) .…”

Bipolar hemiarthroplasty for stage III sickle cell-related avascular necrosis of the femoral head: a successful alternative to total hip replacement

“…Core decompression and intertrochanteric osteotomy are not effective when collapse has already occurred. 2,3 Other methods of treating the condition, such as reconstructing the femoral head using autologous iliac bone grafts, vascularised fibular grafts, and muscle pedicle bone grafts, are laborious in our environment and require multiple hospitalisations with increased costs. It also requires expertise and equipment which we do not have.…”