Introduction: The transtrochanteric rotational osteotomy according to Sugioka is used to preserve the femoral head and to prevent secondary osteoarthritis in young patients with osteonecrosis of the femoral head. Several Japanese studies showed favorable results, but European and American studies were disappointing. However, many factors could be responsible for this outcome including race dependent differences and the followed post-operative rehabilitation program. The purpose of our study was to investigate this transtrochanteric rotational osteotomy in Caucasian patients with osteonecrosis in which we followed the original method of Sugioka as close as possible including a 6 months period of non-weightbearing.

Methods: In a single surgeon prospective study we included 26 hips in 22 consecutive patients who were followed for 8.7 years (range, 6.6–10 years) after surgery. The average age at time of surgery was thirty-two years (range, 22–49 years). No patient was lost to follow up. According the ARCO classification, 7 hips were in stage 2, 2 hips in stage 3 early and 17 hips in stage 3 late.

Results: At review 17 hips had been converted to total hip arthroplasty; 2 for infection, 3 for failed osteosyntheses or non-healing of the osteotomy, 12 for progressive osteoarthritis. Taking conversion to total hip arthroplasty for any reason or Harris Hip Score below 70 as endpoint, the clinical survival rate using the Kaplan-Meier analysis was 56 per cent after 7 years (95% C.I. 36–76%). Patients with a higher age at time of surgery had a tendency to a lower clinical survival rate. Taking conversion to total hip arthroplasty, progression of collapse of the femoral head or progression of osteoarthritis of the femoral head as endpoint, the radiological survival rate using the Kaplan-Meier analysis was 89 per cent after 1 year (95% C.I. 68–100%) for patients without pre-operative collapse of the femoral head. For patients with a pre-operative collapse of the femoral head, this survival rate was 35 per cent after 1 year (95% C.I. 13–58%).

Conclusion: Even after excluding the failures due to problems with osteosynthesis the results were not satisfying and the osteoarthritic process was not delayed in an effective way. Based on our results we cannot recommend this technique as an alternative for total hip arthroplasty in Caucasians.