Transtrochanteric Rotational Osteotomy for Osteonecrosis

Transtrochanteric Rotational Osteotomy For Osteonecrosis Of The Femoral Head -Minimun 5-Year Follow-Up

Tamon Kabata(1), Tadami Matsumoto(2), Ayumi Kaneuji(2), Tanzo Sugimori(2), Toru Ichiseki(2), Hidefumi Ebara(1), Toru Maeda(1), Daigo Sakagoshi(1), Katsuro Tomita(1)

(1) Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
(2) Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Japan

Objective: The purpose of this study was to evaluate the clinical results of the Sugioka’s transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head.

Methods: We reviewed 54 hips in 49 patients who underwent TRO between 1986 and 1998 (Follow-up rate was 90%). The mean age of patients was thirty-six years. The average duration of follow-up was 116 months (range, 60 to 201 months). The cause of osteonecrosis was steroids in 23 patients, idiopathic in 15 patients, alcohol in 13 patients, and others in three patients. On the staging system of Japanese investigation committee of the Ministry of Health and Welfare, 16 hips were in Stage 2, 23 hips in Stage 3A, 13 hips in Stage 3B, and two hips in Stage 4. Clinical assessments were made according to the Japanese Othopaedics Association hip scoring system (JOA score).

Results: The overall results were excellent (90 to 100 points in JOA score) in 22 hips (40.7 %), good (80 to 89 points) in 16 hips (29.6%), fair (65 to 79 points) in 3 hips (5.5%), and poor (fewer than 64 points) in 13 hips (24.1%). The result was influenced by post-operative complications, the ratio of transposed intact femoral articular surface to the acetabular weight-bearing area after TRO, and the pre-operative stage. All hips with the ratio less than 40% showed progressive collapse. All Stage 2 hips with the ratio more than 40% showed excellent or good results. On the other hand, 19% and 25% were fair or poor in Stage 3A and 3B hips even though the ratio was more than 40%. All Stage 4 hips were poor.

Conclusions: We conclude that satisfactory results can be achieved using TRO by maintaining exact surgical technique and by limiting the surgical indications. The hips in early or intermediate stage with sufficient intact area are good candidates for TRO.