Transtrochanteric rotational osteotomy for various hip disorders.

Area of Science:

• Orthopedic Surgery
• Hip Preservation
• Regenerative Medicine

Background:

• Joint-preserving procedures are crucial for pediatric and young patients with hip disorders.
• Optimal treatment for extensive femoral head osteonecrosis (ON) with severe collapse and secondary osteoarthritis (OA) remains unclear.
• Transtrochanteric rotational osteotomy (TRO) is evaluated for its utility in these challenging cases.

Purpose of the Study:

• To investigate the postoperative outcomes of transtrochanteric rotational osteotomy (TRO) in young patients with hip disorders.
• To evaluate the usefulness of TRO as a standalone or combined treatment for advanced secondary OA and ON of the hip.
• To assess the efficacy of TRO in preserving joint function and preventing disease progression.

Main Methods:

• Retrospective study of 11 patients (11 hips) with a mean age of 22 years and a mean follow-up of 9.4 years.
• Diagnoses included secondary OA (6 patients) and ON (5 patients).
• Patients underwent TRO alone or with combination treatments (distraction arthroplasty, intra-articular procedures). Clinical outcomes (Merle d'Aubigne and Postel score) and radiographic changes were assessed.

Main Results:

• Mean Merle d'Aubigne and Postel score improved significantly in both OA (10.3 to 14.2) and ON (9.4 to 14.8) groups.
• Osteoarthritis (OA) grade was maintained or improved in 91% of hips.
• Progressive collapse was prevented in all osteonecrosis (ON) patients, with good femoral head remodeling observed.

Conclusions:

• Transtrochanteric rotational osteotomy (TRO) facilitates hip joint repair and prevents OA progression, even in highly degenerative conditions.
• TRO demonstrates significant utility as a salvage operation for young patients with advanced secondary hip OA and ON.
• The procedure shows promise in preserving joint function and preventing further deterioration in complex hip pathologies.