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

Abstract

Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

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] .…”

Managing AVN following internal fixation: Treatment options and clinical results

“…These previous operations can result in increased operative time, increased blood loss, malpositioning of implants, special removal equipment, and intraoperative osteotomies and potential compromise of long-term implant survival [82][83][84].…”

Osteonecrosis of the femoral head: An update in year 2012

“…Transtrochanteric rotational osteotomy has historically demonstrated variable success for avoidance of femoral head collapse [43,45,81] . Exploration of the risk factors revealed that higher age, higher BMI, and higher stages of osteonecrosis were determinants of likelihood of conversion of osteotomies to THA [82] .…”