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The repair process of osteonecrosis after a transtrochanteric rotational osteotomy
Takuaki Yamamoto1, Satoshi Ikemura, Yukihide Iwamoto
1Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yamataku@ortho.med.kyushu-u.ac.jp
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.
