Abstract
Introduction
Osteonecrosis of the femoral head is usually progressive, and once collapse of the femoral head develops, joint destruction almost invariably follows. Therefore, for partial osteonecrosis of the femoral head, various types of osteotomies have been developed in an attempt to save the femoral head and maintain the natural function of the hip joint.
Materials and methods
We reviewed 25 hips in 21 patients for a mean follow-up period of 6.4 years after Sugioka’s transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head.
Results
The clinical results were excellent or good in 20 hips (80%), and radiological success was observed in 15 hips (60%) with an absence of both collapse of the newly established weight-bearing area of the femoral head and narrowing of the joint space. Progressive collapse of the transposed necrotic area was noted in 10 hips (40%), and of these 10 hips, narrowing of the joint space was observed in 7 (70%) at follow-up. A significant correlation was demonstrated between progressive collapse of the transposed necrotic area and narrowing of the joint space. Growth of an osteophyte of the femoral head was observed postoperatively in 16 hips (64%), particularly at anterior and lateral sites of the femoral head.
Conclusions
Though collapse of a new weight-bearing area can be prevented, progressive collapse of the transposed necrotic area induces anterior joint instability, giving rise to osteoarthritic change. It is therefore concluded that prevention of the collapse of the transposed necrotic area is important for satisfactory long-term results.
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References
Chernetsky SG, Mont MA, LaPorte DM et al (1999) Pathologic features in steroid and nonsteroid associated osteonecrosis. Clin Orthop 368:149–161
Dean MT, Cabanela ME (1993) Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg Br 75:597–602
Eyb R, Kotz R (1987) The transtrochanteric anterior rotational osteotomy of Sugioka. Early and late results in idiopathic aseptic femoral head necrosis. Arch Orthop Trauma Surg 106:161–167
Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67:3-9
Iwasada S, Hasegawa Y, Iwase T, Kitamura S, Iwata H (1997) Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. 43 patients followed for at least 3 years. Arch Orthop Trauma Surg 116:447–453
Iwasada S, Hasegawa Y, Kitamura S, Yamauchi K, Iwata H (2000) Osteophyte of the femoral head after transtrochanteric rotational osteotomy. J Orthop Sci 5:349–355
Iwata H, Torii S, Hasegawa Y et al (1993) Indications and results of vascularized pedicle iliac bone graft in avascular necrosis of the femoral head. Clin Orthop 295:281–288
Kim YM, Ahn JH, Kang HS, Kim HJ (1998) Estimation of the extent of osteonecrosis of the femoral head using MRI. J Bone Joint Surg Br 80:954–958
Langlais F, Fourastier J (1997) Rotation osteotomies for osteonecrosis of the femoral head. Clin Orthop 343:110–123
Leung PC, Chow YYN (1984) Reconstruction of proximal femoral defects with a vascular-pedicled graft. J Bone Joint Surg Br 66:32–37
Lim ST, Kim YM, Rhyu KH et al (2002) Development of pain in untreated asymptomatic hips with nontraumatic osteonecrosis of the femoral head. Proceedings of 69th annual meeting in AAOS 416
Masuda T, Matsuno T, Hasegawa I et al (1988) Results of transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head. Clin Orthop 228:69–74
Merle d’Aubigne R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36:451–475
Merle d’Aubigne R, Postel M, Mazabraud A (1965) Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br 47:612–633
Ono K (1986) Diagnostic criteria, stage and type of avascular necrosis of the femoral head (AFH of steroid-induced, alcohol associated or idiopathic in nature). In: Ono K (ed) Annual report of Japanese Investigation Committee for intractable disease: avascular necrosis of the femoral head. Japanese Ministry of Health and Welfare
Sher MA, Jakim I (1993) Intertrochanteric osteotomy and autogenous bone-grafting for avascular necrosis of the femoral head. J Bone Joint Surg Am 75:1119–1133
Sugano N, Takaoka K, Ohzono K et al (1992) Rotational osteotomy for non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 74:734–739
Sugioka Y (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip. A new osteotomy operation. Clin Orthop 130:191–201
Sugioka Y (1984) Transtrochanteric rotational osteotomy in the treatment of idiopathic and steroid-induced femoral head necrosis, Perthes’ disease, slipped capital femoral epiphysis, and osteoarthritis of the hip. Indication and results. Clin Orthop 184:12–23
Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop 277:111–120
Tooke SMT, Amstutz HC, Hedley AK (1987) Results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. Clin Orthop 224:150–157
Yasunaga Y, Ikuta Y, Omoto O et al (2000) Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head with preoperative superselective angiography. Arch Orthop Trauma Surg 120:437–440
Yasunaga Y, Hisatome T, Ikuta Y, Nakamura S (2001) A histological study of the necrotic area after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br 83:167–170
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Hisatome, T., Yasunaga, Y., Takahashi, K. et al. Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic change. Arch Orthop Trauma Surg 124, 77–81 (2004). https://doi.org/10.1007/s00402-003-0610-0
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DOI: https://doi.org/10.1007/s00402-003-0610-0