Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger.
BACKGROUND
For young patients with osteonecrosis of the femoral head, especially those younger than 20 years, a joint-preserving operation may be one of the surgical treatment options to be considered. We investigated the clinical and radiological results of transtrochanteric anterior rotational osteotomy for the treatment of osteonecrosis of the femoral head in patients 20 years or younger.


METHODS
Between 1976 and 2001, a transtrochanteric anterior rotational osteotomy was performed in 28 hips of 23 patients aged 20 years or younger with osteonecrosis of the femoral head. Among them, 27 hips of 22 patients with a minimum follow-up duration of 2 years were investigated (follow-up rate, 96.4%). They included 7 males and 15 females with a mean age of 16 years at the time of surgery. The mean follow-up period was 14.7 years (range, 2.0-31.7 years). The clinical assessment was made based on the Merle d'Aubigné-Postel score. The postoperative intact ratio, joint-space narrowing, and progression of collapse were all investigated radiographically.


RESULTS
Two (7.4%) of the 27 hips required total hip arthroplasty because of restrictions in the range of motion, whereas the original hip joints in 25 (92.6%) of the 27 hips were preserved at the time of final follow-up. The mean preoperative Merle d'Aubigné-Postel score was 10.4 points, which improved to 15.9 points at the final follow-up (P < 0.0001). The mean postoperative intact ratio was 49.8% (range, 30-100). Five (18.5%) of the 27 hips had a progressive joint-space narrowing, but progression of the collapse was not observed in anyhips.


CONCLUSIONS
Transtrochanteric anterior rotational osteotomy appears to be a useful joint-preserving operation for patients younger than 20 years.


METHODS
Level 4 (Therapeutic Study).
Ikemura
Satoshi
S
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Yamamoto
Takuaki
T
Nakashima
Yasuharu
Y
Mawatari
Taro
T
Motomura
Goro
G
Iwamoto
Yukihide
Y
D000293:Adolescent; D000367:Age Factors; D002648:Child; D018450:Disease Progression; D005260:Female; D005270:Femur Head / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult