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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 12/2010

01-12-2010 | Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

The Repair Process of Osteonecrosis After a Transtrochanteric Rotational Osteotomy

Authors: Takuaki Yamamoto, MD, PhD, Satoshi Ikemura, MD, PhD, Yukihide Iwamoto, MD, PhD, Yoichi Sugioka, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2010

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Abstract

Background

Many studies have reported the factors influencing the progression of collapse and development of osteoarthritis after a transtrochanteric rotational osteotomy. It is not well understood how the healing process of the osteonecrotic area occurs after this procedure.

Questions/purposes

We evaluated (1) the osteonecrotic area after a successful transtrochanteric rotational osteotomy radiographically; and (2) determined whether specific perioperative clinical and radiographic factors related to the difference(s) in the healing process after a transtrochanteric rotational osteotomy.

Methods

We retrospectively reviewed 64 patients (70 hips) among 402 patients (507 hips) who had a transtrochanteric rotational osteotomy between 1981 and 1996 and showed no evidence of progression of collapse or joint space narrowing at 10 years after the osteotomy. Forty-eight hips (45 patients) were males and 22 (19 patients) were females, with a mean age of 37 years (range, 12–57 years) at the time of surgery. An anterior rotational osteotomy was performed for 57 hips and a posterior rotational osteotomy was performed for 13 hips. We recorded various perioperative factors potentially influencing repair and assessed the radiographs at last followup for various features indicating repair.

Results

Ten years after the transtrochanteric rotational osteotomy, the osteonecrotic area in 50 hips (71%) had osteosclerotic changes radiographically (Group I), while 20 hips (29%) had normal bony architecture without sclerotic changes (Group II). We observed no difference between Groups I and II with regard to the age, gender, use of corticosteroids, etiology, and radiographic stage.

Conclusions

Although the reason for this difference in the healing patterns remains unknown, this study indicates the majority of the hips showed osteosclerosis after a transtrochanteric rotational osteotomy, while approximately 30% of the hips showed a normal bony architecture.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Bullough PG. Injury and repair. In: Bullough PE, ed. Bullough and Vigorita’s Orthopaedic Pathology. 3rd ed. New York, NY: Mosby-Wolfe; 1997:81–106.
2.
Bullough PG, Dicarlo EF. Subchondral avascular necrosis: a common cause of arthritis. Ann Rheum Dis. 1990;49:412–420.CrossRefPubMed
3.
Egan RM, Jun RK. Catastrophic antiphospholipid antibody syndrome presenting with multiple thromboses and sites of avascular necrosis. J Rheumatol. 1994;21:2376–2379.PubMed
4.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed
5.
Hasegawa Y, Yamaguchi J, Kanoh T, Seki T, Kawabe K. Low signal intensity area by magnetic resonance imaging that disappeared after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head. J Orthop Sci. 2008;13:265–268.CrossRefPubMed
6.
Hisatome T, Yasunaga Y, Takahashi K, Ochi M. Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic change: mid-term results of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2004;124:77–81.CrossRefPubMed
7.
Hosokawa A, Mohtai M, Hotokebuchi T, Jingushi S, Sugioka Y. Transtrochanteric rotational osteotomy for idiopathic and steroid-induced osteonecrosis of the femoral head: indications and long-term follow-up. In: Urbaniak JR, Jones JP, eds. Osteonecrosis: Etiology, Diagnosis, and Treatment. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1998:309–314.
8.
Houssiau FA, N’Zeusseu Toukap A, Depresseux G, Maldague BE, Malghem J, Devogelaer JP, Vande Berg BC. Magnetic resonance imaging-detected avascular osteonecrosis in systemic lupus erythematosus: lack of correlation with antiphospholipid antibodies. Br J Rheumatol. 1998;37:448–453.CrossRefPubMed
9.
Kokubo T, Takatori Y, Ninomiya S, Nakamura T, Kamogawa M. Magnetic resonance imaging and scintigraphy of avascular necrosis of the femoral head: prediction of subsequent segmental collapse. Clin Orthop Relat Res. 1992;277:54–60.PubMed
10.
Langlais F, Fourastier J. Rotation osteotomies for osteonecrosis of the femoral head. Clin Orthop Relat Res. 1997;343:110–123.CrossRefPubMed
11.
12.
Miyanishi K, Noguchi Y, Yamamoto T, Irisa T, Suenaga E, Jingushi S, Sugioka Y, Iwamoto Y. Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis based on the postoperative intact ratio. J Bone Joint Surg Br. 2000;82:512–516.CrossRefPubMed
13.
Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–474.PubMed
14.
Mundo J, Peris P, Monegal A, Navasa M, Cervera R, Guañiabens N. Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome. Lupus. 2006;15:304–307.CrossRefPubMed
15.
Nishii T, Sugano N, Ohzono K, Sakai T, Haraguchi K, Yoshikawa H. Progression and cessation of collapse in osteonecrosis of the femoral head. Clin Orthop Relat Res. 2002;400:149–157.CrossRefPubMed
16.
Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, Kadowaki T. Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br. 1991;73:68–72.PubMed
17.
Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;7:601–605.CrossRefPubMed
18.
Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip; a new osteotomy operation. Clin Orthop Relat Res. 1978;130:191–201.PubMed
19.
Sugioka Y. Transtrochanteric rotational osteotomy of the femoral head. In: Macnicol MF, ed. Color Atlas, Text of Osteotomy of the Hip. London, UK: Mosby-Wolfe; 1996:145–156.
20.
Sugioka Y, Hotokebuchi T, Tsutsui H. Transtrochanteric anterior osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Clin Orthop Relat Res. 1992;277:111–120.PubMed
21.
Sugioka Y, Yamamoto T. Transtrochanteric posterior rotational osteotomy for osteonecrosis. Clin Orthop Relat Res. 2008;466:1104–1109.CrossRefPubMed
22.
Takao M, Sugano N, Nishii T, Miki H, Sato Y, Tamura S, Yoshikawa H. Longitudinal quantitative evaluation of lesion size change in femoral head osteonecrosis using three-dimensional magnetic resonance imaging and image registration. J Orthop Res. 2006;24:1231–1239.CrossRefPubMed
23.
Theodorou DJ, Theodorou SJ, Haghighi P, Resnick D. Distinct focal lesions of the femoral head: imaging features suggesting an atypical and minimal form of bone necrosis. Skeletal Radiol. 2002;31:435–444.CrossRefPubMed
24.
Yamamoto T, DiCarlo EF, Bullough PG. The prevalence and clinicopathological appearance of extension of osteonecrosis in the femoral head. J Bone Joint Surg Br. 1999;81:328–332.PubMed
25.
Yamamoto T, Irisa T, Sugioka Y, Sueishi K. Effects of pulse methylprednisolone on bone and marrow tissue. Corticosteroid-induced osteonecrosis in rabbits. Arthritis Rheum. 1997;40:2055–2064.CrossRefPubMed
26.
Yamashita A, Yamamoto T, Jingushi S, Iwamoto Y, Sugioka Y, Sueishi K. Histopathological study of osteonecrosis 19 years after transtrochanteric rotational osteotomy. J Orthop Sci. 2006;11:632–637.CrossRefPubMed
27.
Yasunaga Y, Hisatome T, Ikuta Y, Nakamura S. A histological study of the necrotic area after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2001;83:167–170.CrossRefPubMed
Metadata
Title
The Repair Process of Osteonecrosis After a Transtrochanteric Rotational Osteotomy
Authors
Takuaki Yamamoto, MD, PhD
Satoshi Ikemura, MD, PhD
Yukihide Iwamoto, MD, PhD
Yoichi Sugioka, MD, PhD
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1384-7

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