• avascular necrosis
• core decompression
• early stage
• nonarthroplasty treatment

• meta analysis
• onfh
• osteonecrosis of the femoral head
• review
• transtrochanteric rotational osteotomy
• tro

• Adult
• Humans
• Arthroplasty, Replacement, Hip
• Femur Head/surgery
• Osteonecrosis
• Osteotomy
• Survival Rate
• Translocation, Genetic

• meta-analysis
• osteonecrosis
• femoral head
• hip osteoarthritis
• joint preserving treatments
• transtrochanteric rotational osteotomy
• survival rate

• Arthroplasty, Replacement, Hip
• Femur Head Necrosis/surgery
• Humans
• Osteotomy/adverse effects
• Osteotomy/methods
• Survival Rate
• Treatment Failure

• Femur head necrosis
• Osteotomy

• Hip-preservation surgery
• Osteonecrosis of the femoral head
• Peri-collapse stage

• Femur Head/surgery
• Femur Head Necrosis/surgery
• Hip/surgery
• Humans

Various osteotomies have been introduced to treat osteonecrosis of the femoral head. The purpose of this study was to compare surgical parameters, postoperative limb length discrepancy, and minimum 5-year clinical and radiological results between transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head.

From 2004 to 2009, 103 consecutive TROs (97 patients) followed by 72 consecutive TCVOs (64 patients) were performed for the treatment of osteonecrosis of the femoral head. Of these, 85 patients (91 hips) in the TRO group and 58 patients (65 hips) in the TCVO group completed minimum 5-year clinical and radiological follow-up. The Kaplan-Meier product-limit method was used to estimate survival.

The TCVO group had shorter operation time (p < 0.05) and less estimated blood loss (p = 0.026). Postoperative collapse developed in 26 hips (28.6%) in the TRO group and 7 hips (10.8%) in the TCVO group (p = 0.007). Osteophyte formation was observed in 34 hips (37.4%) in the TRO group and 13 hips (20%) in the TCVO group (p = 0.020). Fifteen hips (16.5%) in the TRO group and 7 hips (10.8%) in the TCVO group underwent conversion total hip arthroplasty (THA). The survival rate at 9 years with radiographic collapse as the endpoint was 68.7% (95% confidence interval [CI], 58.1% to 79.3%) in the TRO group, and 84.7% (95% CI, 71.5% to 97.9%) in the TCVO group. With conversion to THA as the endpoint, the survival rate was 82.2% (95% CI, 73.1% to 91.3%) in the TRO group and 89.2% (95% CI, 81.7% to 96.7%) in the TCVO group.

The comparison indicates that TCVO was better than TRO in terms of surgical parameters including operation time and estimated blood loss while the 9-year survival rates were similar.

• Femur head
• Osteonecrosis
• Transtrochanteric curved varus osteotomy
• Transtrochanteric rotational osteotomy

• Femoral head collapse
• Osteonecrosis of the femoral head
• Rotational osteotomy

• Conversion total hip arthroplasty
• Long-term outcome
• Non-traumatic osteonecrosis of the femoral head
• Osteoarthritic change
• Radiological failure
• Transtrochanteric rotational osteotomy

Transtrochanteric rotational osteotomy (TRO) is a controversial hip-preserving procedure with a variable success rate. The healing process of femoral head osteonecrosis after TRO has been poorly explained till now. This study aimed to evaluate the healing process of previously transposed necrotic lesion after a TRO for nontraumatic osteonecrosis of the femoral head using computed tomography (CT).

Among 52 patients (58 hips) who had preserved original femoral head after TRO, we retrospectively reviewed 27 patients (28 hips) who had undergone sequential CT scans and had no major complication following TRO. The average age was 34 years (range, 18 to 59 years). The mean follow-up period was 9.1 years. We evaluated the reparative process of the transposed osteonecrotic lesion with CT scans.

Plain radiographs of the osteonecrotic lesion revealed sclerotic and lucent changes in 14 hips (50%) and normal bony architecture in the other 14 hips (50%) at the final follow-up. CT scans of the osteonecrotic lesions showed cystic changes with heterogeneous sclerosis in 13 hips (46%), normal trabecular bone with or without small cysts in 9 hips (32%), and fragmentation of the necrotic lesion in 6 hips (22%). Seventeen hips (60%) showed minimal (13 hips) to mild (4 hips) nonprogressive collapse of the transposed osteonecrotic area. The collapse of the transposed osteonecrotic area on the CT scan was significantly associated with the healing pattern (p = 0.009), as all 6 patients (6 hips) with fragmentation of the necrotic lesion had minimal (5 hips) to mild (1 hip) collapse. Furthermore, a significant association was found between the collapse of the transposed osteonecrotic area on the CT scan of 17 hips (60%) and postoperative Harris hip score (p = 0.021). We observed no differences among the healing patterns on CT scans with regard to age, gender, etiology, staging, preoperative lesion type, preoperative intact area, percentage of necrotic area, direction of rotation and immediate postoperative intact area.

The majority of the hips showed incomplete regeneration of the transposed osteonecrotic lesion with cysts, sclerosis, and fragmentation, whereas repair with normal trabecular bone was observed only in one-third of the hips that were preserved after Sugioka TRO.

• Computed tomography
• Femur head necrosis
• Osteotomy
• Repair

•

It is important to accurately diagnose the status of idiopathic osteonecrosis of the femoral head and to consider another possible pathogenesis when a patient with idiopathic osteonecrosis of the femoral head has hip pain even without femoral-head collapse.

A 53-year-old man presented with pain in the right hip. Radiological examination showed idiopathic osteonecrosis of the femoral head (ONFH) combined with a cam lesion. Findings on physical examination were consistent for femoroacetabular impingement. At surgery, we performed isolated arthroscopic correction for the cam lesion but did not use other treatment options such as hip arthroplasty or osteotomies for the ONFH. At the latest follow-up evaluation 3 years after surgery, findings indicted a satisfactory outcome, with a Harris hip score of 93.2 (compared with 76.4 before surgery), no joint-space narrowing, and no collapse of the femoral head. It is important to accurately diagnose the status of idiopathic ONFH and to consider another possible pathogenesis when a patient with idiopathic ONFH has hip pain even without femoral-head collapse.

• Cam impingement
• Hip arthroscopy
• Osteonecrosis of the femoral head

It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.

• Osteonecrosis
• Femoral head
• Conservative treatment
• Core decompression
• Stem cells
• Total hip arthroplasty

• Adult
• Case-Control Studies
• Female
• Femur/surgery
• Femur Head Necrosis/complications
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Humans
• Joint Instability/diagnostic imaging
• Joint Instability/etiology
• Male
• Middle Aged
• Osteoarthritis, Hip/diagnostic imaging
• Osteoarthritis, Hip/etiology
• Osteophyte/diagnostic imaging
• Osteophyte/etiology
• Osteotomy/adverse effects
• Osteotomy/methods
• Severity of Illness Index
• Tomography, X-Ray Computed
• Young Adult

• Adult
• Disease Progression
• Female
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Osteoarthritis, Hip/prevention & control
• Osteotomy/methods
• Treatment Outcome
• White People