Transtrochanteric Anterior Rotational Osteotomy of the Femoral Head in the Treatment of Osteonecrosis Affecting the Hip

Modified Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

“…Using a k-wire bent to 90°as a guide, the transtrochanteric osteotomy site was determined perpendicular to the wire just proximal to the intertrochanteric line. In contrast to Sugioka's technique [27], the greater trochanter was not detached (Fig. 1).…”

“…Therefore, we prefer head-preserving procedures for those who are young and diagnosed early. A report on 474 patients treated with the Sugioka osteotomy [27] revealed a success rate of 78%, with higher success rates seen in cases in earlier stages (stage II had an 89% success rate, stage III 73%, and stage IV 70%), and in cases involving smaller lesions. A comparison of several joint-preserving techniques was made by Saito et al [22].…”

“…Sugioka [27] proposed a transtrochanteric rotational osteotomy (TRO) to preserve the femoral head in young patients when the posterior portion of the femoral head was not involved. By rotating the femoral head, the diseased weight-bearing surface is reestablished by repositioning the femoral head, reducing the forces on the diseased part to prevent collapse and allow healing [16,28].…”

“…Various head preservation procedures have been reported, such as core decompression which reduces bonemarrow pressure [8,21], proximal femoral osteotomy [9], nonvascularized or vascularized bone graft [3,5], and trochanteric or transtrochanteric rotational osteotomy [20,27]. Sugioka's transtrochanteric rotational osteotomy [27] especially is known as an effective head preservation procedure in younger patients.…”

“…Sugioka's transtrochanteric rotational osteotomy [27] especially is known as an effective head preservation procedure in younger patients. Despite some reports of good results, not all have reported success with this procedure [7,26,29].…”