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Progressive Collapse Of Necrotic Area After Osteotomy May Induce Osteoarthritic Change In Cases Of Osteonecrosis Of The Femoral Head

Preventing collapse of the transposed necrotic area is important for satisfactory long-term results in cases of osteonecrosis of the femoral head, according to new research.

"The results of our study of progressive collapse of the transposed necrotic area demonstrated a significant correlation between progressive collapse of the transposed necrotic area and narrowing of the joint space," say Takashi Hisatome and colleagues of Hiroshima University, Japan.

Osteonecrosis of the femoral head is usually progressive, and joint destruction typically follows collapse of the femoral head. Therefore, various types of surgical treatment have been conducted for hip preservation in young patients with osteonecrosis of the femoral head for the purpose of saving the femoral head and maintaining natural hip joint function.

The researchers reviewed the clinical and radiological results of 18 men and 3 women with osteonecrosis of the femoral head who underwent transtrochanteric rotational osteotomy in 25 hips. The osteonecrosis was steroid induced in 11 hips (9 patients), alcohol induced in 11 hips (9 patients), post-traumatic in 2 hips (2 patients), and idiopathic in 1 hip (1 patient).

After a mean follow up of 6.4 years, clinical results were observed as excellent or good in 80% of hips, and radiological success was observed in 60% of hips with an absence of both collapse of the newly established weight-bearing area of the femoral head and narrowing of the joint space.

Progressive collapse of the transposed necrotic area was noted in 40% of hips, and of these, narrowing of the joint space was observed in 70% at follow-up. A significant correlation was demonstrated between progressive collapse of the transposed necrotic area and narrowing of the joint space.

Postoperative osteophyte formation of the femoral head was observed in 60% of stage II hips and in 70% of stage III hips for an overall rate of 64%.

Among patients with a preoperative spherical shape of the femoral head, narrowing of the joint space was not observed at follow-up without progressive collapse of the necrotic area and with maintenance of a spherical shape.




Arch Orthop Trauma Surg 2003 Dec 5;[Epub ahead of print]. "Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic changeMid-term results of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head"

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