J Korean Hip Soc.  2011 Mar;23(1):7-14. 10.5371/jkhs.2011.23.1.7.

Joint Preserving Operations for Femoral Head Osteonecrosis

• Kim KC
• Lee YK
• Ha YC
• Koo KH

• KMID: 2190770
• DOI: http://doi.org/10.5371/jkhs.2011.23.1.7

Abstract

Osteonecrosis of the femoral head mainly occurs in young patients, and the hip joint with osteonecrosis of the femoral head can be preserved by adequate joint-preserving surgery. This review article includes the information, surgical technique, pitfalls and results of several types of joint preserving surgeries.

Keyword

Femoral head; Osteonecrosis; Joint preserving; Surgical treatment

MeSH Terms

Head
Hip Joint
Humans
Joints
Osteonecrosis

Figure

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  Fig. 1 A 34-year old male patient who underwent nonvascularized fibular graft. (A) Preoperative anteroposterior radiograph. (B) T1-weighted coronal MR image. (C) Anteroposterior radiograph and (D) lateral radiograph at postoperative 4 years show slight collapse of the femoral head.

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  Fig. 2 A 38-year old male patient who underwent vascularized fibular graft. (A) Preoperative anteroposterior radiograph. (B) T1-weighted coronal MR image. (C) Anteroposterior radiograph and (D) lateral radiograph at postoperative 4 years show slight collapse of the femoral head.

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  Fig. 3 A 20-year old male patient who underwent transtrochanteric rotational osteotomy. (A) Anteroposterior radiograph and (B) frog leg view show slight collapse of the femoral head. (C) The necrotic zone is located in the anterosuperior aspect of the femoral head on the T1-weighted midsagittal MR image. (D) The proximal segment was rotated anteriorly with a rotational angle of 90°.

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  Fig. 4 A 19-year old male patient who underwent curved intertrochanteric varus osteotomy. (A) Anteroposterior radiograph shows slight collapse of the femoral head. (B) The necrotic zone is located in the medial aspect of the femoral head on the T1-weighted midcoronal MR image. (C) Anteroposterior radiograph immediately after curved intertrochanteric varus osteotomy. (D) Anteroposterior radiograph at postoperative 3 years.

Reference

1. Koo KH, Kim R. Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg Br. 1995. 77:875–880.

2. Koo KH, Song HR, Yang JW, Yang P, Kim JR, Kim YM. Trochanteric rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2001. 83:83–89.

3. Lafforgue P, Dahan E, Chagnaud C, Schiano A, Kasbarian M, Acquaviva PC. Early-stage avascular necrosis of the femoral head: MR imaging for prognosis in 31 cases with at least 2 years of follow-up. Radiology. 1993. 187:199–204.

4. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995. 77:459–474.

5. Ohzono K, Saito M, Takaoka K, et al. Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br. 1991. 73:68–72.

6. 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.

7. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am. 1995. 77:681–694.

8. Israelite C, Nelson CL, Ziarani CF, Abboud JA, Landa J, Steinberg ME. Bilateral core decompression for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2005. 441:285–290.

9. Lieberman JR, Conduah A, Urist MR. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res. 2004. 429:139–145.

10. Steinberg ME, Larcom PG, Strafford B, et al. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2001. 386:71–78.

11. Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996. 324:169–178.

12. Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K. Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res. 1991. 268:140–151.

13. Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH. Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. J Bone Joint Surg Br. 1995. 77:870–874.

14. Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg Am. 1999. 81:200–209.

15. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br. 1995. 77:42–49.

16. Powell ET, Lanzer WL, Mankey MG. Core decompression for early osteonecrosis of the hip in high risk patients. Clin Orthop Relat Res. 1997. 335:181–189.

17. Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM. Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res. 1999. 367:262–271.

18. Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am. 1995. 77:674–680.

19. Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am. 1986. 68:1313–1319.

20. Hungerford DS. Response: the role of core decompression in the treatment of ischemic necrosis of the femoral head. Arthritis Rheum. 1989. 32:801–806.

21. Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res. 2004. 429:131–138.

22. Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am. 2005. 87:2012–2018.

23. Yoo MC, Chung DW, Hahn CS. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res. 1992. 277:128–138.

24. Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am. 1996. 78:204–211.

25. Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics. Clin Orthop Relat Res. 1982. 169:115–126.

26. Atsumi T, Kajiwara T, Hiranuma Y, Tamaoki S, Asakura Y. Posterior rotational osteotomy for nontraumatic osteonecrosis with extensive collapsed lesions in young patients. J Bone Joint Surg Am. 2006. 88:Suppl 3. 42–47.

27. 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 Relat Res. 1992. 277:111–120.

28. Gardeniers JWM. Scoutens A, Arlet J, Gardeniers JWM, Hughes SPF, editors. The ARCO perspective for reaching one uniform staging system of osteonecrosis. 1993. New York: Plenum Press;375–380.

29. Yoon TR, Abbas AA, Hur CI, Cho SG, Lee JH. Modified transtrochanteric rotational osteotomy for femoral head osteonecrosis. Clin Orthop Relat Res. 2008. 466:1110–1116.

30. Kerboul M, Thomine J, Postel M, Merle d'Aubigné R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br. 1974. 56:291–296.

31. Merle D'Aubigné R, Postel M, Mazabraud A, Massias P, Gueguen J, France P. Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br. 1965. 47:612–633.

32. Sakano S, Hasegawa Y, Torii Y, Kawasaki M, Ishiguro N. Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004. 86:359–365.

33. Yasunaga Y, Hisatome T, Tanaka R, Yamasaki T, Ochi M. Curved varus femoral osteotomy for minimal dysplastic hip in patients older than 45 years of age: comparison with rotational acetabular osteotomy. J Orthop Sci. 2005. 10:264–269.