Abstract
Purpose
In this study, postoperative results of intertrochanteric curved varus osteotomy (CVO) for idiopathic osteonecrosis of the femoral head (ION) were studied retrospectively and optimal indication of CVO was considered.
Methods
Between 1995 and 2011, CVO was performed in 51 patients (53 hips) for the treatment of ION in our department. The patients who had the potential to obtain acetabular coverage of more than one-third of the intact articular surface on pre-operative AP hip radiographs in maximum abduction were considered suitable for this operation. For radiological assessment, a ratio of necrotic volume, a ratio of postoperative intact surface on the weight-bearing area, progression of collapse, shortening length of the lower limb, and lateralization of great trochanter were evaluated.
Results
The mean ratio of necrotic volume was 16.9 %. The mean ratio of postoperative intact surface on the weight-bearing area of the femoral head was 51.7 %. The progression of collapse was observed in two hips (ratio of necrotic volume 10.4, 39.8 %; ratio of postoperative intact area 36.5, 38.1 %). The mean shortening length of the lower limb was 9 mm, and the mean lateralization of great trochanter was 3 mm. One hip (ratio of necrotic volume 11.6 %, ratio of intact area 35.8 %) was converted to THA because of the progression of osteoarthritis at 55 months after CVO.
Conclusion
The results of CVO for ION were successful, if this procedure was indicated for cases with intact load-bearing area more than 40 %.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME (2002) Pathogenesis and natural history of osteonecrosis. Semin Arthr Rheum 32:94–124
Ohzono K, Saito M, Takaoka K et al (1991) Natural history of non-traumatic avascular necrosis of the femoral head. J Bone Jt Surg (Br) 73-B:68–72
Nishio A, Sugioka Y (1971) A new technique of the varus osteotomy at the upper end of the femur. Orthop Trauma 20:381–386
Sakano S, Hasegawa Y, Torii Y, Kawasaki M, Ishiguro N (2004) Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head. J Bone Jt Surg (Br) 86(3):359–365
Zhao G, Yamamoto T, Ikemura S, Motomura G, Mawatari T, Nakashima Y, Iwamoto Y (2010) 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 Jt Surg (Br) 92(6):781–786
Sugano N, Kubo T, Takaoka K et al (1999) Diagnostic criteria for non-traumatic osteonecrosis of the femoral head: a multicentre study. J Bone Jt Surg (Br) 81-B:590–595
Sugano N, Atsumi T, Ohzono K et al (2002) The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci 7:601–605
Merle d’Aubigne R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am) 36 -A:451–475
Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM (1999) Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res 367:262–271
Pauwels F (1968) The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle 8:196–210
Merle d’Aubigne R, Postel M, Mazabraud A et al (1965) Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg (Br) 47-B:612–633
Kerboull M, Thomine J, Postel M, Merle d’Aubigne R (1974) The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg (Br) 56-B:291–296
Ito H, Kaneda K, Matsuno T (1999) Osteonecrosis of the femoral head: simple varus intertrochanteric osteotomy. J Bone Joint Surg (Br) 81-B:969–974
Mont MA, Fairbank AC, Krackow KA, Hungerford DS (1996) Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg (Br) 78-B:1032–1038
Miyanishi K, Noguchi Y, Yamamoto T et al (2000) Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg (Br) 82-B:512–516
Belal MA, Reichelt A (1996) Clinical results of rotational osteotomy for treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 115:80–84
Atsumi T, Kuroki Y (1997) Modified Sugiok’s osteotomy: more than 130 degrees posterior rotation for osteonecrosis of the femoral head with large lesion. Clin Orthop 334:98–107
Ikemura S, Yamamoto T, Jingushi S et al (2007) Use of a screw and plate system for a transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. J Orthop Sci 12:260–264
Sugioka Y, Yamamoto T (2008) Transtrochanteric posterior rotational osteotomy for osteonecrosis. Clin Orthop 466:1104–1109
Ikemura S, Yamamoto T, Nakashima Y et al (2009) Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger. J Pediatr Orthop 29:219–223
Sugano N, Takaoka K, Ohzono K et al (1992) Rotational osteotomy for non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg (Br) 74-B:734–739
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hamanishi, M., Yasunaga, Y., Yamasaki, T. et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg 134, 305–310 (2014). https://doi.org/10.1007/s00402-013-1919-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1919-y