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Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

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Clinical Orthopaedics and Related Research®

Abstract

Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18–46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18–156 months). The mean preoperative Harris hip score was 44.7 points (range, 32–62 points) which improved to an average postoperative score of 80.1 points (range, 44–100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

Level of Evidence: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Prof. Man Sik Park (Statistical Analysis of Medicine, Korea University, College of Medicine) for useful advice on the statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Korea University, Guro Hospital, #80, Guro-Dong, Guro-Gu, Seoul, 152-703, South Korea

    Sandeep Biswal MS, Sunit Hazra MS, Ho Hyun Yun MD, Chang Yong Hur MD, PhD & Won Yong Shon MD, PhD

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  1. Sandeep Biswal MS
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  2. Sunit Hazra MS
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Correspondence to Won Yong Shon MD, PhD.

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Biswal, S., Hazra, S., Yun, H.H. et al. Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults. Clin Orthop Relat Res 467, 1529–1537 (2009). https://doi.org/10.1007/s11999-008-0696-3

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