Abstract
Purpose
The purpose of this study was to investigate the factors that affect the joint space narrowing after transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH).
Methods
We reviewed 39 cases (43 hips) of ONFH in patients who underwent ARO between 2000 and 2004. Their mean age was 42 years (23–61) at the time of surgery. The mean follow-up period was 7.3 years (3–10). The following clinical and radiological factors were investigated: the preoperative stage, localization and extent of the necrotic lesion, and the postoperative intact ratio (transposed intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). The 43 hips were divided into two groups: a joint space narrowing (JSN) group and a non-joint space narrowing (non-JSN) group.
Results
Thirty-seven hips (86 %) were categorized as non-JSN and six (14 %) as having JSN. The preoperative Japanese Orthopaedic Association score was significantly higher in the non-JSN group than in the JSN group (P = 0.01). In the non-JSN group, the rate of early stage disease was significantly higher than in the JSN group (P = 0.03). The postoperative intact ratio was significantly higher in the non-JSN group than in the JSN group (P = 0.002). A multivariate analysis revealed that the postoperative intact ratio was an independent predictor of the progression of joint space narrowing after ARO, and the cutoff point was 39.2 %.
Conclusion
The results of this study suggest that the postoperative intact ratio is one of factors determining the progression of joint space narrowing after ARO and that an approximately 40 % or higher postoperative intact ratio is recommended to prevent joint space narrowing.
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References
Fukushima W, Fujioka M, Kubo T, Tamakoshi A, Nagai M, Hirota Y. Nationwide epidemiologic survey of idiopathic osteonecrosis of the femoral head. Clin Orthop. 2010;468:2715–24.
Mont MA, Hungerford DS, Maryland B. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–74.
Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med. 1992;326:1473–9.
Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop. 1978;130:191–201.
Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis: follow-up statistics. Clin Orthop. 1982;169:115–26.
Sugioka Y, Hotokebuchi T, Tsutsui H. Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head: indications and long-term results. Clin Orthop. 1992;277:111–20.
Ikemura S, Yamamoto T, Nakashima Y, Mawatari T, Motomura G, Iwamoto Y. Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger. J Pediatr Orthop. 2009;29:219–23.
Sugano N, Takaoka K, Ohzono K, Matsui M, Saito M, Saito S. Rotational osteotomy for non-traumatic osteonecrosis of the femoral head. J Bone Joint Surg Br. 1992;74:734–9.
Miyanishi K, Noguchi Y, Yamamoto T, Irisa T, Suenaga E, Jingushi S, Sugioka Y, Iwamoto Y. Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2000;82:512–6.
Hosokawa A, Mohtai M, Hotokebuchi T, Jingushi S, Sugioka Y. Transtrochanteric rotational osteotomy for idiopathic and steroid-induced osteonecrosis of the femoral head: indications and long-term follow-up. AAOS. 1998:309–14.
Imura S. Evaluation chart of hip joint functions. Nippon seikeigekagakkai Zasshi (J Jpn Orthop Assoc). 1995;69:864–7 (in Japanese).
Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;7:601–5.
Nam KW, Kim YL, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Fate of untreated asymptomatic osteonecrosis. J Bone Joint Surg Am. 2008;90:477–84.
Zhao G, Yamamoto T, Ikemura S, Motomura G, Mawatari T, Nakashima Y, Iwamoto Y. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg Br. 2010;92:781–6.
Lane NE, Nevitt MC, Hochberg MC, Hung YY, Palermo L. Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women. Arthritis Rheum. 2004;50:1477–86.
Rovati LC. Radiographic assessment. Introduction: existing methodology. Osteoarthritis Cartil. 1999;7:427–9.
Altman RD, Bloch DA, Dougados M, Hochberg M, Lohmander S, Pavelka K, Spector T, Vignon E. Measurement of structural progression in osteoarthritis of the hip: the Barcelona consensus group. Osteoarthritis Cartil. 2004;12:515–24.
Motomura G, Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y. Outcome of the contralateral hip in rapidly distractive arthrosis after total hip arthroplasty. J Arthroplast. 2006;21:1026–31.
Mcneil BJ, keller E, Adelstein SJ. Primer on certain elements of medical decision making. N Engl J Med. 1975;293:211–5.
Hiranuma Y, Atsumi T, Kajiwara T, Tamaoki S, Asakura Y. Evaluation of instability after transtrochanteric anterior rotational osteotomy for nontraumatic osteonecrosis of the femoral head. J Orthop Sci. 2009;14:535–42.
Ha YC, Kim HJ, Kim SY, Kim KC, Lee YK, Koo KH. Effects of age and body mass index on the results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. J Bone Joint Surg Am. 2010;92:314–21.
Hisatome T, Yasunaga Y, Takahashi K, Ochi M. Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic change, mid-term results of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2004;124:77–81.
Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. Long-term results. J Bone Joint Surg Br. 1993;75:597–601.
Iwasada S, Hasegawa Y, Iwase T, Kitamura S, Iwata H. Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. Forty three patients followed for at least 3 years. Arch Orthop Trauma Surg. 1997;116:447–53.
Acknowledgments
This work was supported in part by a Research Grant for Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan and a Grant-in-Aid from the Japan Society for the Promotion of Science (No. 22000514).
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All authors have no conflict of interest to other groups.
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Zhao, G., Yamamoto, T., Ikemura, S. et al. Clinico-radiological factors affecting the joint space narrowing after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. J Orthop Sci 17, 390–396 (2012). https://doi.org/10.1007/s00776-012-0238-4
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DOI: https://doi.org/10.1007/s00776-012-0238-4