SUGIOKA’S TRANSTROCHANTERIC ROTATIONAL OSTEOTOMY IN THE TREATMENT OF OSTEONECROSIS OF THE FEMORAL HEAD

Abstract

Introduction: The results of transtrochanteric rotational osteotomies for osteonecrosis of the femoral head were reviewed.

Materials and Methods: The results of 26 transtrochanteric osteotomy in 24 patients with Ficat stage II or stage III osteonecrosis of the femoral head performed between April 1994 and June 2001 were evaluated. Osteotomy was primarily conducted on patients younger than 50 years of age when the necrotic lesion was at least 30% of the whole femoral head and was located at the superior aspect. Twenty-three hips in 22 patients were available for clinical and radiological follow-up at 59 months (range, 24–109 months). The average age of the patients at the time of the index procedure was 35 years (range, 23–51 years). The results were considered successful if there was no radiologic failure (progression to necrosis, further collapse) or clinical failure (the need for total hip arthroplasty).

Results: Eighteen (78%) hips had a successful result. Two hips showed progressive varus deformity and were treated by valgus osteotomy. One hip survived and one hip underwent a Girdlestone operation followed by total hip arthroplasty to treat an associated deep infection. Four other hips were also subsequently treated with total hip arthropalsty because of head collapse with severe varus deformity or neck fracture in three hips and infection after osteotomy in one hip.

Discussion: Our results suggest that transtrochanteric osteotomy is a dependable procedure in the treatment of a large lesion even in the later stages of osteonecrosis of the femoral head, which is especially true for patients under the age of 50 years.