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- Title
Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results.
- Authors
Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide
- Abstract
<bold>Background: </bold>Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN.<bold>Methods: </bold>This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade).<bold>Results: </bold>The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS.<bold>Conclusions: </bold>Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE.
- Subjects
HIP joint injuries; FEMORAL epiphysis; TREATMENT of bone necrosis; OSTEOTOMY; TOTAL hip replacement; PATIENTS; HIP surgery; BONE screws; OSTEONECROSIS; COMPARATIVE studies; HIP joint; RANGE of motion of joints; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RADIOGRAPHY; RESEARCH; RISK assessment; STATISTICAL sampling; TIME; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies; SEVERITY of illness index; EPIPHYSIOLYSIS; DISEASE complications; EQUIPMENT &; supplies
- Publication
Journal of Orthopaedic Science, 2016, Vol 21, Issue 6, p831
- ISSN
0949-2658
- Publication type
journal article
- DOI
10.1016/j.jos.2016.06.014