Comparison of the Results of Core Decompression and Sugioka's Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head

Moon, Jun Gyu; Wang, Joon Ho; Hur, Chang Yong; Shon, Won Yong

Abstract

PURPOSE
This study conducted a comparative analysis on 49 hips treated with a core decompression procedure and 19 hips treated with a Sugioka's transtrochanteric rotational osteotomy for a osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: This study evaluated the relationship between the Ficat and Arlet Stage and the extent of the necrotic lesion (using Shimizu's Grade Classification), and the clinical outcome of each procedure. The patient's outcomes were assessed after a mean follow-up of 46 months (range=36-82 months) after the core decompression and 53 months (range=37-108 months) after the Sugioka's transtrochanteric rotational osteotomy. The results were considered successful if the patients were asymptomatic with no disease progression, and unsuccessful if there was radiographic (progression of the stage or collapse) or clinical failure (the need for an arthroplasty or subsequent salvage operation). RESULTS: Twenty one out of 49 cases (43%) in the core decompression group and 14 out of 19 (74%) in the rotational osteotomy group showed successful outcomes. In the core decompression group, among the 22 F-A Stage I hips, 15 (68%) hips had survived according to radiological criteria. All four (100%) Shimizu's Grade A hips of the F-A Stage I had successful results, which is in contrast to the 11 hips out of 18 hips (61%) of the Shimizu's Grade B and C hips (p<0.01). Six (38%) out of 16 F-A Stage IIA hips and two (25%) out of eight IIB hips in the core decompression group had successful results, while 11 (85%) out of 13 IIA and two (50%) out of four stage IIB hips in the rotational osteotomy group had successful results. In the F-A Stage III hips, all 2 hips in the Sugioka transtrochanteric rotational osteotomy treatment group had survived, while none of the three Shimizu's Grade C hips in the core decompression group were successful. CONCLUSION: A core decompression is effective only in the earliest stages of osteonecrosis (F-A Stage I), which means that its success strongly depends on the location and extent of the femoral head necrosis. Sugioka's transtrochanteric rotational osteotomy is a more dependable procedure than a core decompression for treating large lesions of nonsteroidal ONFH, particularly for patients under the age of 50.