Trochanteric rotational osteotomy for osteonecrosis of the femoral head

Abstract

The rate of success of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head may be improved if patients are preselected using MRI. We have used three criteria for selection for osteotomy (i) minor collapse of the infarcted area, loss of congruity or the crescent sign, without narrowing of the joint space or acetabular involvement (ii) patients younger than 55 years and with a painful hip (iii) patients with an intact area constituting an arc of more than 120 degrees between the central vertical line of the femoral head and the posterior or anterior margin of the necrotic portion as seen on a midsagittal MRI. Seventeen patients were selected, with a follow-up of more than 42 months. A bone scan four weeks after operation showed adequate perfusion of the proximal segment in all hips. The hip score of Merle d'Aubigné et al improved from 13.5 points before operation to 17.2 points at the latest follow-up. Further collapse of the femoral head did not occur. The use of MRI instead of plain radiographs for the selection of patients has improved the success rate of transtrochanteric rotational osteotomy.

Summary of the various treatments for osteonecrosis of the femoral head by mechanism: A review

“…The process is technically demanding and preserves the shape of the femoral head by altering its weight-bearing status (14). However, a number of studies (15–18) have indicated variable rates of success for the surgery.…”

Posttraumatic Avascular Necrosis of the Femoral Head in Teenagers Treated by a Modified Transtrochanteric Rotational Osteotomy: A Report of Three Cases

“…The literature suggests that surgical intervention (eg, core decompression) in patients with early stage AVN, before the presence of collapse of the femoral head may improve results. 9,[16][17][18] A metaanalytical study by Moon et al concluded that fracture type and the age of the patient were significant predictors of AVN. It reported that older children were 1.14 times more likely to develop AVN for each year of increasing age.…”

Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head

“…1). 18) The criterion for TCVO was an arc of > 150° between the central vertical line of the femoral head and the lateral margin of the necrotic portion on the mid-coronal MRI scan (Fig. 2).…”

“…However, in this procedure, the greater trochanter is osteotomized and the joint capsule is circumferentially incised. The reported success rates of this technique range from 17% to 100% 17,18,19)…”