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Archives of Orthopaedic and Trauma Surgery

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01-12-2016 | Orthopaedic Surgery

What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head?

Authors: Toshiaki Okura, Yukiharu Hasegawa, Daigo Morita, Yusuke Osawa, Naoki Ishiguro

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2016

Abstract

Introduction

The purpose of this study was to examine the 10-year survivorship and clinical outcome after curved intertrochanteric varus osteotomy (CVO) for the osteonecrosis of the femoral head (ONFH), and to determine what factors predict the failure of this procedure.

Materials and methods

We retrospectively reviewed 102 consecutive CVOs in 93 patients diagnosed with ONFH. Mean follow-up duration was 10.1 years (3.0–23.2 years). Factors associated with radiographic failure (secondary collapse and/or osteoarthritic change), conversion to total hip arthroplasty (THA) and low Harris Hip Score (HHS), were assessed. The Kaplan–Meier method was used to estimate survival rate.

Results

Radiographic failure occurred in 27 hips (26.5 %), and 11 hips (10.8 %) were converted to THA. The 10-year survival rate was 91.0 % [95 % confidence interval (CI) 83.4–95.2 %] with conversion to THA as the endpoint and 72.4 % (95 % CI 62.3–80.3 %) with radiographic failure as the endpoint. Mean HHS improved from 70.0 preoperatively to 88.1 at the final follow-up (p < 0.001). Multivariate Cox regression analysis showed that postoperative intact ratio <33.3 % [hazard ratio (HR), 11.17; 95 % CI 4.14–30.14] and center-edge (CE) angle <25° (HR 4.91; 95 % CI 1.92–12.55) were independent factors determining radiographic failure. In addition, the multivariate Cox regression analysis showed that postoperative intact ratio <33.3 % (HR 10.65; 95 % CI 2.24–50.53) and CE angle <25° (HR 7.81; 95 % CI 2.17–28.07) were also factors determining conversion to THA. Worse HHSs of <80 were seen in patients with postoperative intact ratio <33.3 % (p < 0.001), CE angle <25° (p < 0.001), and acetabular head index <75 % (p = 0.006).

Conclusions

Postoperative intact ratio <33.3 % and CE angle <25° were identified as independent factors determining radiographic failure and conversion to THA. Therefore, these factors must be taken into consideration when selecting patients for CVO.

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Title: What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head?
Authors: Toshiaki Okura
Yukiharu Hasegawa
Daigo Morita
Yusuke Osawa
Naoki Ishiguro
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2563-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head?

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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