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High-degree posterior rotational osteotomy for extensive collapsed femoral head osteonecrosis in teenagers: remodeling and results with a mean of 10-year follow-up

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study evaluated the effectiveness of high-degree posterior rotational osteotomy for teenagers with extensively collapsed femoral head osteonecrosis.

Materials and methods

We reviewed 40 hips in 35 patients with severely collapsed femoral head osteonecrosis treated by this procedure with a mean follow-up period of 9.7 years (range 5–25 years).

Thirteen hips had a history of steroid administration. Nine had slipped capital femoral epiphysis. Nine had femoral neck fracture. Two had traumatic dislocation and fracture. Seven had no apparent risk factors. The mean age of the patients (18 women and 17 men) was 14.8 years. All femoral heads were extensively collapsed below the acetabular roof, and 20 hips showed preoperative joint space narrowing (ARCO stage 4). Lateral radiographs of the femoral head revealed extensive lesions from the posterior to anterior portion. The mean degree of posterior rotation was 118° with intentional varus positioning [mean: 19° (range 10–30)]. The pre- and postoperative extent of the viable area of the femoral head was assessed using conventional anteroposterior radiographs and 45-degree flexion radiography. Further collapse, joint space narrowing, femoral head morphology, and congruency with the acetabulum based on the Stulberg classification were assessed using conventional anteroposterior radiographs. The clinical assessment was conducted using the Merle d’Aubigné hip scores at the last follow-up.

Results

The viable area of the femoral head on the loaded portion was seen during a short period after operations. The necrotic lesions were gradually improved postoperatively. The mean extent of viable bone below the acetabular roof was 48% at less than 6 months after surgery and 92% at the final follow-up. The mean extent on 45° flexion radiography was 54% at less than 6 months after surgery and 89% at the final follow-up. Further collapse was prevented in 38 hips (95%). In 19 of 20 hips with preoperative narrowing of the joint space, the joint space was first improved, but narrowing progressively observed in 9 of 40 hips at the final follow-up. Thirty-four hips had excellent or good clinical outcomes, whereas 6 had fair or poor outcomes.

Conclusions

We concluded that this procedure is effective at delaying the progression of degeneration if adequate area of viable bone can be moved under the loaded portion of the acetabulum in teenagers with severe femoral head osteonecrosis.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The authors received no financial support for the research, authorship, or publication of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawaku, Tokyo, 142-8666, Japan

    Takashi Atsumi, Yasushi Yoshikawa, Masanori Nishi & Katsunori Inagaki

  2. Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashi-Cho, Nishitokyo-Shi, Tokyo, 188-0011, Japan

    Takashi Atsumi & Masanori Nishi

  3. Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aobaku, Yokohama, Kanagawa, 227-8501, Japan

    Ryosuke Nakanishi & Minoru Watanabe

Authors
  1. Takashi Atsumi
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  2. Ryosuke Nakanishi
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  3. Yasushi Yoshikawa
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  4. Minoru Watanabe
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  5. Masanori Nishi
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  6. Katsunori Inagaki
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Corresponding author

Correspondence to Takashi Atsumi.

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Each authors certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee of the Showa University Hospital (No. F2018C16).

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The requirement for informed consent was waived because of the retrospective nature of the study.

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Atsumi, T., Nakanishi, R., Yoshikawa, Y. et al. High-degree posterior rotational osteotomy for extensive collapsed femoral head osteonecrosis in teenagers: remodeling and results with a mean of 10-year follow-up. Arch Orthop Trauma Surg 143, 6039–6048 (2023). https://doi.org/10.1007/s00402-023-04864-4

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