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The Repair Process of Osteonecrosis After a Transtrochanteric Rotational Osteotomy

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Takuaki Yamamoto MD, PhD, Satoshi Ikemura MD, PhD, Yukihide Iwamoto MD, PhD & Yoichi Sugioka MD, PhD

Authors
  1. Takuaki Yamamoto MD, PhD
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  2. Satoshi Ikemura MD, PhD
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  3. Yukihide Iwamoto MD, PhD
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  4. Yoichi Sugioka MD, PhD
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Corresponding author

Correspondence to Takuaki Yamamoto MD, PhD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

One of the authors (TY) received funding from Grant-in-Aid for Japan Society for the Promotion of Science (Number 21591948), Research Grant for Intractable Diseases from the Ministry of Health and Welfare of Japan, and grant from Takeda Science Foundation; and one of the authors (SI) received funding from Research Fellowships of the Japan Society for the Promotion of Science for Young Scientists (Number 211160).

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Yamamoto, T., Ikemura, S., Iwamoto, Y. et al. The Repair Process of Osteonecrosis After a Transtrochanteric Rotational Osteotomy. Clin Orthop Relat Res 468, 3186–3191 (2010). https://doi.org/10.1007/s11999-010-1384-7

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  • DOI: https://doi.org/10.1007/s11999-010-1384-7

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