Transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head in young adults.
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.


METHODS
Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
Biswal
Sandeep
S
Department of Orthopaedic Surgery, Korea University, Guro Hospital, #80, Guro-Dong, Guro-Gu, Seoul, 152-703, South Korea.
Hazra
Sunit
S
Yun
Ho Hyun
HH
Hur
Chang Yong
CY
Shon
Won Yong
WY
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome