Clin Orthop Surg.  2017 Jun;9(2):160-168. 10.4055/cios.2017.9.2.160.

Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head

• Lee YK
• Park CH
• Ha YC
• Kim DY
• Lyu SH
• Koo KH

• KMID: 2412283
• DOI: http://doi.org/10.4055/cios.2017.9.2.160

Abstract

BACKGROUND
Various osteotomies have been introduced to treat osteonecrosis of the femoral head. The purpose of this study was to compare surgical parameters, postoperative limb length discrepancy, and minimum 5-year clinical and radiological results between transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head.
METHODS
From 2004 to 2009, 103 consecutive TROs (97 patients) followed by 72 consecutive TCVOs (64 patients) were performed for the treatment of osteonecrosis of the femoral head. Of these, 85 patients (91 hips) in the TRO group and 58 patients (65 hips) in the TCVO group completed minimum 5-year clinical and radiological follow-up. The Kaplan-Meier product-limit method was used to estimate survival.
RESULTS
The TCVO group had shorter operation time (p < 0.05) and less estimated blood loss (p = 0.026). Postoperative collapse developed in 26 hips (28.6%) in the TRO group and 7 hips (10.8%) in the TCVO group (p = 0.007). Osteophyte formation was observed in 34 hips (37.4%) in the TRO group and 13 hips (20%) in the TCVO group (p = 0.020). Fifteen hips (16.5%) in the TRO group and 7 hips (10.8%) in the TCVO group underwent conversion total hip arthroplasty (THA). The survival rate at 9 years with radiographic collapse as the endpoint was 68.7% (95% confidence interval [CI], 58.1% to 79.3%) in the TRO group, and 84.7% (95% CI, 71.5% to 97.9%) in the TCVO group. With conversion to THA as the endpoint, the survival rate was 82.2% (95% CI, 73.1% to 91.3%) in the TRO group and 89.2% (95% CI, 81.7% to 96.7%) in the TCVO group.
CONCLUSIONS
The comparison indicates that TCVO was better than TRO in terms of surgical parameters including operation time and estimated blood loss while the 9-year survival rates were similar.

Keyword

Femur head; Osteonecrosis; Transtrochanteric rotational osteotomy; Transtrochanteric curved varus osteotomy

MeSH Terms

Adolescent
Adult
Female
Femur Head/diagnostic imaging/*surgery
Femur Head Necrosis/diagnostic imaging/epidemiology/mortality/*surgery
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Operative Time
Osteotomy/*methods/statistics & numerical data
Postoperative Complications
Young Adult

Figure

• 

  Fig. 1 A 35-year-old man had osteonecrosis in the left femoral head. (A) Preoperative anteroposterior hip radiograph. (B and C) The combined necrotic angle was 240°. (B) The angle of the necrotic area in the mid-coronal image was 90°. (C) The angle of the necrotic area in the mid-sagittal image was 150°. The angle between the central vertical line of the femoral head and the posterior margin of the necrotic portion was 135°. (D) Immediate postoperative anteroposterior hip radiograph after transtrochanteric rotational osteotomy. (E) Follow-up radiograph taken 6 years after the operation showing osteophyte formation around the femoral head.

• 

  Fig. 2 A 28-year-old woman had osteonecrosis in the left femoral head. (A) Preoperative anteroposterior hip radiograph. (B and C) The angle of the necrotic area in the mid-coronal images of computed tomography and magnetic resonance imaging was 110°. The angle between the central vertical line of the femoral head and the lateral margin of the necrotic portion was 150°. (D) Immediate postoperative anteroposterior hip radiograph after curved intertrochanteric varus osteotomy. (E) Follow-up radiograph taken 6 years after the operation showing no progressing collapse or osteophyte formation around the femoral head.

• 

  Fig. 3 Survival curves with collapse on the radiograph as the endpoint (A) and conversion to total hip arthroplasty as the endpoint (B). TRO: transtrochanteric rotational osteotomy, TCVO: transtrochanteric curved varus osteotomy.

Reference

1. Merle D'Aubigne 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(4):612–633.

2. Kerboul M, Thomine J, Postel M, Merle d'Aubigne R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br. 1974; 56(2):291–296.

3. Katz RL, Bourne RB, Rorabeck CH, McGee H. Total hip arthroplasty in patients with avascular necrosis of the hip: follow-up observations on cementless and cemented operations. Clin Orthop Relat Res. 1992; (281):145–151.

4. Kim YH, Oh JH, Oh SH. Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 1995; (320):73–84.

5. Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004; 86(2):177–184.

6. Lee YK, Ha YC, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Alumina-on-alumina total hip arthroplasty: a concise follow-up, at a minimum of ten years, of a previous report. J Bone Joint Surg Am. 2010; 92(8):1715–1719.

7. Hwang KT, Kim YH, Kim YS, Choi IY. Cementless total hip arthroplasty with a metal-on-metal bearing in patients younger than 50 years. J Arthroplasty. 2011; 26(8):1481–1487.

8. Kang BJ, Ha YC, Ham DW, Hwang SC, Lee YK, Koo KH. Third-generation alumina-on-alumina total hip arthroplasty: 14 to 16-year follow-up study. J Arthroplasty. 2015; 30(3):411–415.

9. Mont MA, Fairbank AC, Krackow KA, Hungerford DS. Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Am. 1996; 78(7):1032–1038.

10. Nishio A, Sugioka Y. A new technique of the varus oste-otomy at the upper end of the femur. Orthop Traumatol. 1971; 20(3):381–386.

11. Ikemura S, Yamamoto T, Jingushi S, Nakashima Y, Mawatari T, Iwamoto Y. Leg-length discrepancy after transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2007; 89(6):725–729.

12. Ito H, Kaneda K, Matsuno T. Osteonecrosis of the femoral head: simple varus intertrochanteric osteotomy. J Bone Joint Surg Br. 1999; 81(6):969–974.

13. Saito S, Ohzono K, Ono K. Joint-preserving operations for idiopathic avascular necrosis of the femoral head: results of core decompression, grafting and osteotomy. J Bone Joint Surg Br. 1988; 70(1):78–84.

14. 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(3):359–365.

15. Zhao G, Yamamoto T, Ikemura S, et al. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg Br. 2010; 92(6):781–786.

16. 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.

17. Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head: long-term results. J Bone Joint Surg Br. 1993; 75(4):597–601.

18. 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(1):83–89.

19. Ha YC, Kim HJ, Kim SY, Kim KC, Lee YK, Koo KH. Effects of age and body mass index on the results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. J Bone Joint Surg Am. 2010; 92(2):314–321.

20. Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg Br. 1985; 67(1):3–9.

21. Smith SW, Meyer RA, Connor PM, Smith SE, Hanley EN Jr. Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head. J Bone Joint Surg Am. 1996; 78(11):1702–1706.

22. D'Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954; 36(3):451–475.

23. Lausten GS, Hesse B, Thygesen V, Fogh J. Prediction of late complications of femoral neck fractures by scintigraphy. Int Orthop. 1992; 16(3):260–264.

24. Swezey RL, Bjarnason DM. Inhibition of secondary osteophyte formation in rheumatoid arthritis. Rheumatol Rehabil. 1976; 15(1):10–16.

25. Jacobsen S, Sonne-Holm S, Soballe K, Gebuhr P, Lund B. The relationship of hip joint space to self reported hip pain: a survey of 4.151 subjects of the Copenhagen City Heart Study: the Osteoarthritis Substudy. Osteoarthritis Cartilage. 2004; 12(9):692–697.

26. Woolson ST, Hartford JM, Sawyer A. Results of a method of leg-length equalization for patients undergoing primary total hip replacement. J Arthroplasty. 1999; 14(2):159–164.

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

28. Hisatome T, Yasunaga Y, Takahashi K, Ochi M. Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic change: mid-term results of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2004; 124(2):77–81.

29. Miyanishi K, Noguchi Y, Yamamoto T, et al. Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2000; 82(4):512–516.

30. Rijnen WH, Gardeniers JW, Westrek BL, Buma P, Schreurs BW. Sugioka's osteotomy for femoral-head necrosis in young Caucasians. Int Orthop. 2005; 29(3):140–144.

31. Sugano N, Takaoka K, Ohzono K, Matsui M, Saito M, Saito S. Rotational osteotomy for non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Br. 1992; 74(5):734–739.

32. Jacobs MA, Hungerford DS, Krackow KA. Intertrochanteric osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg Br. 1989; 71(2):200–204.