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《Chinese Journal of Surgery》 2004-24
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Transtrochateric rotational osteotomy for osteonecrosis of the femoral head

ZHANG Nian-fei, LIZi-rong, YANG Lian-fa, LIN Peng, SHI Zhen-cai, LI Zhong-shi, SUN Wei. Osteonecrosis and Joint-Preserving and Reconstraction Center, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China  
Objective To explore the indications, operative technique and clinical results of the transtrochanteric rotational osteotomy ( TRO ) for osteonecrosis of the femoral head ( ONFH) . Methods Nineteen patients (23 hips) with ONFH underwent TRO from October 1992 to May 2001 were reviewed. There were 14 males and 5 females. The age was ranging from 22 to 43 years old with an average age of 33. 4 years old. The etiology were as followed: alcoholism 10 cases (12 hips) ; steroid 6 cases (7 hips); trauma 2 cases (2 hips) ; caisson disease 1 case (2 hips). Ficat stage: Ⅱ 8cases 8 hips; Ⅲ 11 cases 15 hips. Harris hip score 46 to 74 with mean score 56 preoperatively. In order to determine the location and extent of osteonecrosis, A-P view and accurats lateral view (the film should be placed parallel to the femoral neck with the hip in precisely 90° and flexion 45° of abduction and neutral rotation) were taken in both hips preoperatively. The surgical technique described by Sugioka were used in all patients. Results Seventeen patients(19 hips) were followed up ranging from 18 to 11 years with mean 54 months. The Harris hip score was from 55 to 94 with mean 80. 5. Fourteen hips score more than 80 and good to excellent rate was 73. 2% . Harris score were less than 79 in 5 cases and 4 hips of these 5 hips were revised by total hip arthroplasty. The rotation angle was from 55°to 80°with mean 60°. Complications: The circumflex femoral medial artery injury was found in 1 hip; subtrochanteric fracture was found in 2 hips and 1 osteotomy site nonunion occured. Conclusion TRO can be used to treat ONFH. The indications include:(1) younger patients (less than 45 years old). (2) Ficat stage Ⅱ and Ⅲ with more than one third intact articular surface of the femoral head. The better results could be obtained using posterior rotation and lager rotational angle. The Sugioka osteotomy should be used carefully because of its complicated surgical technique
【CateGory Index】: R687
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