The transtrochanteric anterior rotational osteotomy (TRO) was developed by Sugioka as a joint-preserving procedure which prevents further deformity by transposing the necrotic area from a site of primary weight-bearing to a secondary area. We performed this procedure for children and young adults with various hip disorders. Between 1994 and 2015 we performed TROs on 12 joints in 12 patients with SCFE (4), pigmented villonodular synovitis (2), septic arthritis (1), FAI (1), hip dysplasia (1), femoral neck fracture (2) and postoperative RAO (1). The mean age at the time of surgery was 21 years (10–43) and the mean follow-up period was 8 years (1–22). The rotational directions of the femoral head were anterior (5) and posterior (7). Clinical assessment was undertaken using the system of Merle d'Aubigné and Postel, grading pain, mobility and walking ability with scores from 0 to 6. Radiographically bone regeneration and OA progression were estimated. The mean clinical score improved from 9.0 to 14.4 at final follow-up. Spur formation of femoral head was observed in 7 patients (58%). OA progression was in two patients (17%) and one patient was converted to THA 22 years after surgery. All cases with osteonecrosis in SCFE and femoral neck fracture showed remarkable bone regeneration. The TRO is a reliable joint-preserving procedure for various hip disorders in children and young adults.
In Japan, osteoarthritis (OA) of the hip secondary
to acetabular dysplasia is very common, and there are few data concerning
the pathogeneses and incidence of femoroacetabular impingement (FAI).
We have attempted to clarify the radiological prevalence of painful
FAI in a cohort of Japanese patients and to investigate the radiological findings.
We identified 176 symptomatic patients (202 hips) with Tönnis grade
0 or 1 osteoarthritis, whom we prospectively studied between August
2011 and July 2012. There were 61 men (65 hips) and 115 women (137
hips) with a mean age of 51.8 years (11 to 83). Radiological analyses
included the α-angle, centre–edge angle, cross-over sign, pistol
grip deformity and femoral head neck ratio. Of the 202 hips, 79
(39.1%) had acetabular dysplasia, while 80 hips (39.6%) had no known
aetiology. We found evidence of FAI in 60 hips (29.7%). Radiological
FAI findings associated with cam deformity were the most common.
There was a significant relationship between the pistol grip deformity
and both the α-angle (p <
0.001) and femoral head–neck ratio
(p = 0.024). Radiological evidence of symptomatic FAI was not uncommon
in these Japanese patients. Cite this article:
