Rotational osteotomy for non-traumatic avascular necrosis of the femoral head

Abstract

We reviewed 41 hips in 40 patients at three to 11 years (average 6.3 years) after Sugioka transtrochanteric rotational osteotomy for non-traumatic avascular necrosis of the femoral head. The clinical results were excellent or good in 23 hips (56%) and the radiological success rate was 56%. Failure was due to fracture of the femoral neck, nonunion of the osteotomy, secondary collapse, or osteoarthritis. Nonunion and femoral neck fracture were more common after the use of the large screws described by Sugioka than with AO blade plates. Secondary collapse was significantly more common when less than one-third of the posterior articular surface was intact (p = 0.002). Postoperative degenerative changes were seen in cases with stage III avascular necrosis. We conclude that success depends to a large extent on the amount and stage of necrosis of the femoral head, but that careful technique and the use of AO hip plates may increase the likelihood of a satisfactory result.

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

“…Our data showed Shimizu Grade c location is another risk factor for progressive collapse (Table 1). We observed no difference between Ficat Stages II and III even though some authors reported success also depends on stage [33,39].…”

“…Rijnen et al [31] also stated the technique in Caucasian patients was more demanding for TRO owing to the different dimension of the hips and larger body size and weight of the patients. Sugano et al [39] reported a 56% success rate in 41 hips at mean followup of 6.3 years and considered skillful performance of the technique one of the important factors for success of TRO. We also experienced progressive varus deformity in seven of 44 hips (16%) with multiple cannulated screw fixation and negative uptake on the postoperative bone scan in one hip early in this series.…”

“…Some authors, including Saito et al and Sugano et al [32,39], have pointed out inappropriate patient selection in relation to the extent of necrosis of the femoral head and stage of necrosis. Eyb and Kotz [9] also concluded TRO is indicated only for young patients with good function and sectors of necrosis of the femoral head up to 90°.…”

“…Progressive varus deformity was attributable to not only 6.5-mm cannulated screw fixation but also to the additional varus position of the proximal part of the femur despite prolonged partial or nonweightbearing after TRO. Another important postoperative complication is neck fracture [29,32,39]. Sugano et al [39] reported failure was attributable to complications, including six (15%) postoperative fractures of the femoral neck.…”

“…Another important postoperative complication is neck fracture [29,32,39]. Sugano et al [39] reported failure was attributable to complications, including six (15%) postoperative fractures of the femoral neck. Sugioka et al [41] reported femoral neck fractures were observed in four of 474 hips after TRO and the hip complex obtained was disproportionate with respect to mechanical strength and weightbearing capability, resulting in subsequent neck fracture.…”