Transtrochanteric rotational osteotomy for various hip disorders

Joint-preserving procedures should be considered as much as possible for hip disorders in pediatric and young patients. However, in patients with extensive osteonecrosis (ON) of the femoral head combined with severe collapse and advanced secondary osteoarthritis (OA), the optimal procedure has not been elucidated. This retrospective study aimed to investigate the postoperative outcomes of 11 patients who underwent transtrochanteric rotational osteotomy (TRO) alone or with a combination treatment for various hip disorders in young patients and to evaluate the usefulness of TRO.

Eleven patients (11 hips) with a mean age at operation of 22 years were included. The mean follow-up duration was 9.4 years. Preoperative diagnosis was secondary OA in 6 patients (pigmented villonodular synovitis, 2; after rotational acetabular osteotomy, 1; pyogenic arthritis, 1; femoroacetabular impingement, 1; acetabular dysplasia, 1) and ON in 5 patients (slipped capital femoral epiphysis, 4; femoral neck fracture, 1). Combination treatment was performed in 2 patients with distraction arthroplasty and in 6 patients with intra-articular procedures (mosaicplasty, 1; drilling, 1; microfracture, 4; cam resection, 1). Clinical evaluation was performed by using the Merle d'Aubigne and Postel score (MDPS). Joint congruency and progression of osteoarthritic change in all cases, and progression of collapse in the ON patients were evaluated radiographically.

The mean MDPS improved from 10.3 to 14.2 in the OA patients and from 9.4 to 14.8 in the ON patients. The OA grade was maintained or improved in 10 hips (91%). Progressive collapse was prevented in all ON patients, and good remodeling was demonstrated.

Even in the highly degenerative cases, TRO enabled repair and prevention of the progression of OA. This procedure might be a useful salvage operation for treating secondary OA and ON of the hip even if the clinical condition is advanced, especially in young patients.