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Zhu J, Chen K, Peng J, Li Y, Shen C, Chen X. Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions. J Hip Preserv Surg 2021; 7:713-720. [PMID: 34377514 PMCID: PMC8349588 DOI: 10.1093/jhps/hnab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022] Open
Abstract
In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.
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Affiliation(s)
- Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Kangming Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, No. 12, Wulumuqizhong Road, Shanghai 200040, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
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Xu M, Motomura G, Ikemura S, Yamaguchi R, Utsunomiya T, Baba S, Kawano K, Nakashima Y. Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: A three-dimensional simulation study. Orthop Traumatol Surg Res 2020; 106:1569-1574. [PMID: 33153958 DOI: 10.1016/j.otsr.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transtrochanteric posterior rotational osteotomy (PRO) is one of the joint-preserving surgeries for osteonecrosis of the femoral head. In general, postoperative femoral neck-shaft varus realignment is planned to obtain a sufficient intact articular surface of the femoral head in the weight-bearing portion. Unlike anterior rotational osteotomy, PRO allows for more than 90° rotation of the femoral head, resulting in more complicated morphology. However, little is known about the potential risk of postoperative femoral retroversion after PRO. This simulation study aims: 1) to assess whether postoperative femoral neck-shaft varus realignment can coexist with preserved femoral anteversion after PRO, 2) and whether postoperative proximal femoral morphology could be predicted with approximation equations. HYPOTHESIS High degree (>90°) PRO is favourable for femoral neck-shaft varus realignment, but unfavourable for maintaining postoperative femoral anteversion. MATERIALS AND METHODS PRO was simulated by using CT data from 10 hips in 10 healthy volunteers. During simulation, the intertrochanteric osteotomy plane was determined three-dimensionally based on anteroposterior-view line (the osteotomy line on anteroposterior view) and lateral-view line (the osteotomy line on lateral view). By changing either the angle of anteroposterior-view line or lateral-view line, we simulated 90°, 110°, 130° and 150° PRO. To clarify the effects of various posterior rotation angles on postoperative proximal femoral morphology, we made simplified PRO models through changing only the posterior rotation angle. RESULTS In the 90°, 110°, 130° and 150° PRO models, the vertically inclined angle of anteroposterior-view line showed a significant positive correlation with femoral neck-shaft varus realignment (90° PRO, r=0.90; 110° PRO, r=0.95; 130° PRO, r=0.97; 150° PRO, r=0.99), while a significant negative correlation with postoperative femoral anteversion angle (90° PRO, r=-0.97; 110° PRO, r=-0.95; 130° PRO, r=-0.92; 150° PRO, r=-0.7). Likewise, the posteriorly tilted angle of lateral-view line showed a significant negative correlation with both femoral neck-shaft varus realignment (90° PRO, r=-0.81; 110° PRO, r=-0.81; 130° PRO, r=-0.79; 150° PRO, r=-0.72) and postoperative femoral anteversion angle (90° PRO, r=-0.90; 110° PRO, r=-0.89; 130° PRO, r=-0.92; 150° PRO, r=-0.88). In the simplified PRO models, the posterior rotation angle showed a significant positive correlation with femoral neck-shaft varus realignment (r=0.33), while a significant negative correlation with postoperative femoral anteversion angle (r=-0.76). The approximation equations for predicting the proximal femoral morphology after PRO were validated. DISCUSSIONS It was confirmed that high-degree PRO (>90°) is favourable for femoral neck-shaft varus realignment, but works against preserving femoral anteversion. With the approximation equations developed in the current study, surgeons could examine the feasibility of PRO based on postoperative femoral anteversion. In terms of hip joint function and subsequent total hip arthroplasty, excessive deformities including femoral retroversion and severe varus deformity could be avoided. LEVEL OF EVIDENCE IV; case series without control group.
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Affiliation(s)
- Mingjian Xu
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Goro Motomura
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan.
| | - Satoshi Ikemura
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Shoji Baba
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Koichiro Kawano
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
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Sonoda K, Motomura G, Ikemura S, Kubo Y, Yamamoto T, Nakashima Y. Effects of intertrochanteric osteotomy plane and preoperative femoral anteversion on the postoperative morphology of the proximal femur in transtrochanteric anterior rotational osteotomy: 3D CT-based simulation study. Orthop Traumatol Surg Res 2017; 103:1005-1010. [PMID: 28782700 DOI: 10.1016/j.otsr.2017.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transtrochanteric anterior rotational osteotomy (ARO) is joint-preserving surgery for patients with osteonecrosis of the femoral head (ONFH). During ARO, femoral neck-shaft varus angulation by changing intertrochanteric osteotomy plane is often designed to obtain a sufficient postoperative intact ratio. However, the effect of intertrochanteric osteotomy plane on postoperative femoral anteversion has not been well examined. Therefore, we performed a simulation study of ARO to determine how intertrochanteric osteotomy plane and preoperative femoral anteversion affect both femoral neck-shaft varus angle and postoperative femoral anteversion. HYPOTHESIS Both femoral neck-shaft varus angle and postoperative femoral anteversion are predicted by intertrochanteric osteotomy plane and preoperative femoral anteversion in ARO. MATERIALS AND METHODS Using CT-data obtained from 10 hips in 10 patients with ONFH, ARO was simulated. On anteroposterior view, basic intertrochanteric osteotomy line (AP-view line) was defined as the perpendicular line to the femoral neck axis. On lateral view, basic intertrochanteric osteotomy line (lateral-view line) made through the cut surface of greater trochanter was defined as the perpendicular line to the lateral axis of the femur. By changing either AP-view or lateral-view line, 49 ARO models/hip were produced, in which femoral neck-shaft varus angle and postoperative femoral anteversion were assessed. RESULTS With increase in the vertically-inclined degree of AP-view line, both neck-shaft varus angle and postoperative femoral anteversion increased. With increase in the posteriorly-tilted degree of lateral-view line, neck-shaft varus angle increased, whereas postoperative femoral anteversion decreased. The approximation equations based on the multiple regression analyses were as follows: neck-shaft varus angle≈vertically-inclined degree of AP-view line×0.9+posteriorly-tilted degree of lateral-view line×0.8+preoperative femoral anteversion×0.7; postoperative femoral anteversion≈vertically-inclined degree of AP-view line×1.1-posteriorly-tilted degree of lateral-view line×0.8. DISCUSSION The postoperative morphology of proximal femur was nearly defined by intertrochanteric osteotomy plane with preoperative femoral anteversion, which is useful for preoperative planning in terms of both achieving a sufficient postoperative intact ratio and maintaining femoral anteversion. LEVEL OF EVIDENCE Level IV case series without control group.
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Affiliation(s)
- K Sonoda
- Department of orthopaedic surgery, graduate school of medical sciences, Kyushu university, 3-1-1 Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
| | - G Motomura
- Department of orthopaedic surgery, graduate school of medical sciences, Kyushu university, 3-1-1 Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan.
| | - S Ikemura
- Department of orthopaedic surgery, graduate school of medical sciences, Kyushu university, 3-1-1 Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
| | - Y Kubo
- Department of orthopaedic surgery, graduate school of medical sciences, Kyushu university, 3-1-1 Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
| | - T Yamamoto
- Department of orthopaedic surgery, faculty of medicine, Fukuoka university, 7-45-1 Nanakuma, 814-0180 Jonan-ku, Fukuoka, Japan
| | - Y Nakashima
- Department of orthopaedic surgery, graduate school of medical sciences, Kyushu university, 3-1-1 Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
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Takao M, Sakai T, Hamada H, Sugano N. Error range in proximal femoral osteotomy using computer tomography-based navigation. Int J Comput Assist Radiol Surg 2017; 12:2087-2096. [PMID: 28365906 DOI: 10.1007/s11548-017-1577-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/21/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE : The purpose of this preliminary study was to determine the error range compared with preoperative plans in proximal femoral osteotomy conducted using a computed tomography (CT)-based navigation system. METHODS : Four patients (four hips) underwent transtrochanteric rotational osteotomy (TRO), and three patients (four hips) underwent curved varus osteotomy (CVO) using CT-based navigation. Volume registration of pre- and postoperative CT was performed for error assessment. RESULTS : In TRO, the mean osteotomy angle error was [Formula: see text] (range [Formula: see text]) in the valgus direction and [Formula: see text] (range [Formula: see text]) in the retroversion direction. The mean osteotomy position error, with the femoral head side as positive, was -0.4 mm (range -1.4 to 0 mm). The bone fragment rotational movement error was [Formula: see text] (range [Formula: see text]). In CVO, the mean osteotomy position error, with the femoral head side as positive, was -0.2 mm (range -2.0 to 1.7 mm) at the level of the lesser trochanter and 0.8 mm (range 0-3.2 mm) at the level of the greater trochanter. Bone fragment varus accuracy was [Formula: see text] (range [Formula: see text]). CONCLUSIONS : In proximal femoral osteotomy using CT-based navigation, the angle error of osteotomy was within [Formula: see text] and the positional error was within 4 mm. The rotational movement error of the proximal fragment was within [Formula: see text]. These margins of error should be considered in preoperative planning. To improve surgical accuracy, it would be necessary to develop a computer-assisted device which can track the osteotomized fragment.
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Affiliation(s)
- Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takashi Sakai
- Departments of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Hamada
- Departments of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
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