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Transtrochanteric Rotational Osteotomy for a Subchondral Insufficiency Fracture of the Femoral Head in Young Adults

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While subchondral insufficiency fracture of the femoral head is most frequently seen in elderly patients, this fracture has also been reported in some young individuals.

Questions/purposes

We asked whether a transtrochanteric rotational osteotomy for a subchondral insufficiency fracture of the femoral head in young adults would (1) provide improvement in functional scores; and (2) lead to healing of the fractures.

Methods

We retrospectively reviewed five young patients diagnosed with subchondral insufficiency fracture of the femoral head. Nonoperative treatment was administered initially. Four of these patients (average 22.3, years; range, 16–29 years) showed progressive collapse. An anterior rotational osteotomy was performed in these four patients since the fractured area was located in the anterosuperior portion of the femoral head. All patients were followed for a minimum of 2.0 years (average, 4.1 years; range, 2.0–9.1 years).

Results

The average preoperative Harris hip score was 71.6 points, which improved to an average of 97.2 at the latest followup. Radiographically, the fractured lesion healed and no progression of collapse was observed in any of the four patients.

Conclusions

Anterior rotational osteotomy seems a useful surgical option for treating young patients with subchondral insufficiency fracture of the femoral head if symptoms persist.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    CAS  PubMed  Google Scholar 

  2. 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. In: Urbaniak JR, Jones JP, eds. Osteonecrosis: Etiology, Diagnosis, and Treatment. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1998:309–314.

  3. Ikemura S, Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y. Bilateral subchondral insufficiency fracture of the femoral head after renal transplantation. Arthritis Rheum. 2005;52:1293–1296.

    Article  PubMed  Google Scholar 

  4. 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 based on the postoperative intact ratio. J Bone Joint Surg Br. 2000;82:512–516.

    Article  CAS  PubMed  Google Scholar 

  5. Pødenphant J, Engel U. Regional variations in histomorphometric bone dynamics from the skeleton of an osteoporotic woman. Calcif Tissue Int. 1987;40:184–188.

    Article  PubMed  Google Scholar 

  6. Rafii M, Mitnick H, Klug J, Firooznia H. Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol. 1997;168:159–163.

    CAS  PubMed  Google Scholar 

  7. Song WS, Yoo JJ, Koo KH, Yoon KS, Kim YM, Kim HJ. Subchondral fatigue fracture of the femoral head in military recruits. J Bone Joint Surg Am. 2004;86:1917–1924.

    PubMed  Google Scholar 

  8. Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip; a new osteotomy operation. Clin Orthop Relat Res. 1978;130:191–201.

    PubMed  Google Scholar 

  9. Sugioka Y, Hotokebuchi T, Tsutsui H. Transtrochanteric anterior osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Clin Orthop Relat Res. 1992;277:111–120.

    PubMed  Google Scholar 

  10. Vande Berg BC, Malghem J, Goffin EJ, Duprez TP, Maldague BE. Transient epiphyseal lesions in renal transplant recipients: presumed insufficiency stress fractures. Radiology. 1994;191:403–407.

    Google Scholar 

  11. Visuri T. Stress osteopathy of the femoral head: 10 military recruits followed for 5–11 years. Acta Orthop Scand. 1997;68:138–141.

    Article  CAS  PubMed  Google Scholar 

  12. Yamamoto T, Bullough PG. Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum. 1999;42:2719–2723.

    Article  CAS  PubMed  Google Scholar 

  13. Yamamoto T, Iwamoto Y, Schneider R, Bullough PG. Histopathologic prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis. 2008;67:150–153.

    Article  CAS  PubMed  Google Scholar 

  14. Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y. Subchondral insufficiency fracture of the femoral head in younger adults. Skeletal Radiol. 2007;36:S38–S42.

    Article  PubMed  Google Scholar 

  15. Yamamoto T, Schneider R, Bullough PG. Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol. 2000;24:464–468.

    Article  CAS  PubMed  Google Scholar 

  16. Yamamoto T, Schneider R, Bullough PG. Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skeletal Radiol. 2001;30:247–254.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Takuaki Yamamoto MD, PhD, Kenyu Iwasaki MD & Yukihide Iwamoto MD, PhD

Authors
  1. Takuaki Yamamoto MD, PhD
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  2. Kenyu Iwasaki MD
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  3. Yukihide Iwamoto MD, PhD
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Corresponding author

Correspondence to Takuaki Yamamoto MD, PhD.

Additional information

One of the authors (TY) was funded by a Grant-in-Aid in Scientific Research (Number 21591948) from Japan Society for the Promotion of Science, Research Grant for Intractable Diseases from the Ministry of Health and Welfare of Japan and a grant from Takeda Science Foundation.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Yamamoto, T., Iwasaki, K. & Iwamoto, Y. Transtrochanteric Rotational Osteotomy for a Subchondral Insufficiency Fracture of the Femoral Head in Young Adults. Clin Orthop Relat Res 468, 3181–3185 (2010). https://doi.org/10.1007/s11999-010-1364-y

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  • DOI: https://doi.org/10.1007/s11999-010-1364-y

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