Femoral Osteotomies for Osteonecrosis of the Femoral Head

Femoral osteotomy is performed for osteonecrosis of the femoral head to prevent the progression of collapse and promote the repair process by transposing the necrotic lesion to the nonweight-bearing portion. The purpose of this review article was to summarize the current knowledge on two types of femoral osteotomy: transtrochanteric anterior or posterior rotational osteotomy and transtrochanteric curved varus osteotomy, both of which are currently performed for osteonecrosis, mainly in Japan and Korea. Osteotomy can be expected to cure osteonecrosis, and no matter how much the durability of artificial joints improves, there will always be young patients for whom the procedure is indicated. We should continue to verify the results of this surgery and refine the techniques involved.

Evaluation of transtrochanteric rotational osteotomy for avascular necrosis of hip: a case series

<p class="abstract">Osteonecrosis, also referred to as avascular necrosis (AVN), aseptic necrosis and ischemic necrosis, is not a specific disease but rather a condition in which a circumscribed area of bone becomes necrotic as a result of a loss of its blood supply. The femoral head is the site most often affected and its frequent cause is a displaced fracture through the femoral neck. This is a case-series study that has been done on 9 patients (10 hips) with clinical and radiological evidence of osteonecrosis of head of femur. After treatment patients were followed clinically and radiographically at 1 to 3 months intervals during first year after the operation and at 3 to 6 months intervals thereafter. Out of 9 study subjects, 7 (77.7%) were male and 2 (22.2%) were female. Mean age was 40±7.5. Among 7 (70%) hips, canulated cancellous screws were used and dynamic hip screw were used in 3 (30%) hips. Majority of the cases, 4 (40%) had more than 2 mm of progressive collapse of transported intact area in their latest follow up. Transtrochanteric rotational osteotomy procedure is valuable and needs to be tried by new genre of orthopedician as it helps in clinical improvement of patient and might also delay the necessity for total hip arthroplasty.</p>

Supracondylar rotation osteotomy of the femur influences the coronal alignment of the ankle

Purpose Osteotomies represent well-established treatment-options for the redistribution of loads and forces within and around the knee-joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal-femoral-rotation-osteotomy on the coronal alignment of the ankle. It was hypothesized that supracondylar-external-rotation-osteotomy of the distal femur leads to a change in the coronal orientation of the ankle joint. Methods Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar-rotational-osteotomy of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy-site. The hip-knee-ankle-angle (HKA), the mechanical-lateral-distal-femur-angle (mLDFA), and Tibia-Plafond-Horizontal-Orientation-Angle (TPHA) around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results Twenty-seven patients with high femoral antetorsion (31.3° ± 4.0°) underwent supracondylar-external-rotation-osteotomy. The osteotomy led to a reduced antetorsion (17.4 ± 5.1; p < 0.001) and to a valgisation of the overall limb-alignment. The HKA decreased by 2.4° ± 1.4° (p < 0.001). The TPHA decreased by 2.6° (p < 0.001). Conclusions Supracondylar external rotation osteotomy of the femur leads to lateralization of the weight bearing line at the knee and ankle due to valgisation of the coronal limb alignment. The mobile subtalar joint has to compensate (inversion) for the resulting valgus orientation of the ankle to ensure contact between the foot and the floor. When planning a rotational osteotomy of the lower limb, this should be appreciated – especially in patients with a preexisting valgus alignment of the lower extremities or restricted mobility in the subtalar joint.

Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions

In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.