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The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 665 - 671
1 Apr 2021
Osawa Y Seki T Okura T Takegami Y Ishiguro N Hasegawa Y

Aims

We compared the clinical outcomes of curved intertrochanteric varus osteotomy (CVO) with bone impaction grafting (BIG) with CVO alone for the treatment of osteonecrosis of the femoral head (ONFH).

Methods

This retrospective comparative study included 81 patients with ONFH; 37 patients (40 hips) underwent CVO with BIG (BIG group) and 44 patients (47 hips) underwent CVO alone (CVO group). Patients in the BIG group were followed-up for a mean of 12.2 years (10.0 to 16.5). Patients in the CVO group were followed-up for a mean of 14.5 years (10.0 to 21.0). Assessment parameters included the Harris Hip Score (HHS), Oxford Hip Score (OHS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), complication rates, and survival rates, with conversion to total hip arthroplasty (THA) and radiological failure as the endpoints.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VIII | Pages 12 - 12
1 Mar 2012
Koo KH Ha YC Lee YK Yoo JJ Kim HJ
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Introduction. Osteonecrosis of the femoral head occurs in young patients. The preservation of the hip joint is vitally important, because hip arthroplasty does not guarantee satisfactory long-term results in young and active patients. Curved intertrochanteric varus osteotomy is one of several joint preserving procedures used for this disease. Methods. Between June 2004 and June 2007, 52 patients (55 hips) who had osteonecrosis of the femoral head were treated with curved intertrochanteric varus osteotomy. There were 29 men and 23 women who had a mean age at the time of osteotomy of 33 years (range, 18 to 52 years). The osteotomy was fixed with a 120 degree compression hip screw in the first 34 hips and with a 95 degree dynamic condylar screw in the remaining 21 hips. Clinical evaluation was performed using the scoring system of Merle d'Aubigne et al. Results. The mean duration of follow-up was 32 months (range, 24 to 60 months). Six patients (six hips) required a total hip arthroplasty, due to loss of fixation in two hips, shortening of the operated limb in two hips, and further collapse with persistent pain in two hips. In two patients (two hips), the plate fractured at 3 and 4 months after the operation, which was changed to a new plate. Thus, 49 of the 55 hips survived at a mean follow-up 32 months. In these hips, the mean Merle d'Aubigne hip score was 17.4 points at the latest evaluation. Conclusion. Curved intertrochanteric varus osteotomy is a satisfactory joint preserving method to treat osteonecrosis of the femoral head


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 329 - 329
1 May 2009
Koo K Kang B Jeong J Yoo J Kim H
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Introduction: Osteonecrosis of the femoral head occurs in young patients. The preservation of the hip joint is vitally important because hip replacement arthroplasty is associated with high rates of failure in young and active patients. Curved intertrochanteric varus osteotomy is one of several joint preserving procedures used to treat these patients. Methods: Between June 2003 and June 2006, 46 patients (49 hips) who had osteonecrosis of the femoral head were treated with curved intertrochanteric varus osteotomy. There were 23 men and 23 women who had a mean age at the time of osteotomy was 33 years (range, 17 to 51 years). The osteotomy was fixed with a 120 degree compression hip screw in the first 34 hips and with a 95 degree dynamic condylar screw in the remaining 15 hips. Clinical evaluation was performed using the scoring system of Merle d’Aubigne et al. Radiological failure of the operation was defined as further collapse of the femoral head by more than 2 mm or progressive narrowing of the joint space compared with the immediate postoperative radiograph. Results: The mean duration of follow-up was 22 months (range, 12 to 48 months). One patient (one hip) required a total hip arthroplasty due to loss of fixation and penetration of the lag screw into the joint space. In two patients (two hips), the plate fractured at 3 and 4 months after the operation, which was changed to a new plate. Thus, 48 of the 49 hips survived at a mean follow-up 22 months. In these 48 hips, the mean Merle d’Aubigne hip score was 17.2 points at latest evaluation and there was no instance of radiologic failure. Discussion: Curved intertrochanteric varus osteotomy is a satisfactory joint preserving method to treat osteonecrosis of the femoral head


The Journal of Bone & Joint Surgery British Volume
Vol. 86-B, Issue 3 | Pages 359 - 365
1 Apr 2004
Sakano S Hasegawa Y Torii Y Kawasaki M Ishiguro N

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31° was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months.

We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.