title: Long-term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head.
abstract: We have previously described the mid- to long-term results of conventional simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head, showing that 19 of the 26 hips had good or excellent results. We extended the follow-up to a mean of 18.1 years (10.5 to 26) including a total of 34 hips in 28 patients, with a mean age at surgery of 33 years (19 to 53). There were 18 men and ten women and 25 hips (74%) had a satisfactory result with a Harris hip score ≥ 80. In all, six hips needed total hip replacement (THR) or hemiarthroplasty. The collapse of the femoral head or narrowing of the joint space was found to have progressed in nine hips (26%). Leg shortening after osteotomy was a mean of 19 mm (8 to 36). With conversion to THR or hemiarthroplasty as the endpoint, the ten-year survival rate was 88.2% (95% confidence interval (CI) 82.7 to 93.7) and the 20-year survival rate was 79.7% (95% CI 72.1 to 87.3); four hips were converted at ten years and other two hips were converted at 20 years. Shortening of the leg after osteotomy remains a concern; however, the conventional varus half-wedge osteotomy provides favourable long-term results in hips with less than two-thirds of the medial part of the femoral head affected by necrotic bone and with normal bone superolaterally.
authors.affiliation: Asahikawa Medical University, Department of Orthopaedic Surgery, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan. itohiro@asahikawa-med.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Ito
authors.forename: H
authors.initials: H
authors.lastname: Tanino
authors.forename: Y
authors.initials: Y
authors.lastname: Yamanaka
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: D
authors.initials: D
authors.lastname: Takahashi
authors.forename: A
authors.initials: A
authors.lastname: Minami
authors.forename: T
authors.initials: T
authors.lastname: Matsuno
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D019644:Arthroplasty, Replacement, Hip; D004812:Epidemiologic Methods; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids