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Abstract
Purpose
The results of Sugioka's transtrochanteric rotational osteotomy are controversial. While many Japanese studies have reported favorable results, European and American studies have been disappointing. We present the results of Sugioka's rotational osteotomy for extensive osteonecrosis of the femoral head in young patients.
Methods and Materials
Between April. 1994 and May. 2004, Sugioka's osteotomy was performed for osteonecrosis involving a large part of the weight bearing area on 49 hips (46 patients). Of these 49 hips, 45 (43 patients) were available for follow-up. The patients were followed up for at least 2 years with an average of 52 months (range: 24-132 months). The major causes of osteonecrosis were chronic alcohol abuse in 33 hips. The mean age of the patients at the time of surgery was 31 years (range: 21-46), and the male to female ratio was 39:6. Six, 17 and 22 hips were classified as stage IIA, IIb and III using the Ficat and Alert classification, respectively.
Results
Thirty three of the 45 hips (74%) survived clinically and radiologically. Of these, the clinical results were excellent, good and fair in 15, 12 and 6 hips, respectively. Major complications were encountered in 12 hips [Progressive severe varus deformity in 7 hips (15%)], femur neck fracture in 3 hips (6%) and deep infection in 2 hips (4%). Among these 12 hips, seven hips (15%) required secondary THA. Five other hips (11%) were also subsequently converted to THA due to progressive collapse of the femoral head after the transtrochanteric osteotomy.
Figures and Tables
Fig. 1
Radiographic findings of a 22-year-old man with alcohl induced ONFH collapse mild collapse of the left hip. (A) Preoperative atero-posterior radiograph of both hip joints, showing the collapse of the left femoral head (Ficat-Arlet stage IIb and Shimizu extent type C). (B) Preoperative radiograph (Sugioka's view) of both hip joints, showing the collapse of the left femoral head (Ficat-Arlet stage IIb and Shimizu extent type C). (C, D) Preoperative T2 weighted coronal MRI of both hips showing decreased signal intensity of the left femoral head (Ficat-Arlet stage IIb and Shimizu extent type C).
Fig. 2
Radiographic findings of a 22-year-old man with alcoholic ONFH with mild collapse of the left hip. (A) Immediate postoperative radiograph of both hip joints, anteroposterior view showing the transtrochanteric rotational osteotomy of left hip joint. (B) Postoperatively radiograph of both hip joints, anteroposterior view at one year after the osteotomy, showing preservation of the femoral head contour and joint space.
Fig. 3
Radiographic findings of a 22-year-old man with alcoholic ONFH with mild collapse of the left hip. (A) Postoperative radiograph of both hip joints. Anteroposterior view five years after the osteotomy showing preservation of the femoral head contour and joint space. (B) Postoperatively radiograph of both hip joints. Anteroposterior view ten year after the osteotomy showing preservation of the femoral head contour and joint space.
Fig. 4
Radiographic findings of a 27-year-old man with idiopathic ONFH with mild collapse of the left hip. (A) Preoperative radiograph of both hip joints. Anteroposterior view showing the collapse of left femoral head (Ficat-Arlet stage III and Shimizu extent type C). (B) Preoperative radiograph of both hip joints. Sugioka's view showing the collapse of left femoral head (Ficat-Arlet stage III and Shimizu extent type C). (C) Preoperative T2 weighted coronal MRI of both hip joints showing decreased signal intensity of the left femoral head (Ficat-Arlet stage III and Shimizu extent type C). (D) Preoperative T2 weighted axial MRI of both hip joints showing decreased signal intensity of left femoral head (Ficat-Arlet stage III and Shimizu extent type C).
Fig. 5
Radiographic findings of a 27-year-old man with idiopathic ONFH with mild collapse of the left hip. (A) Immediate postoperatively radiograph of both hip joints. Anteroposterior view showing the transtrochanteric rotational osteotomy of the left hip joint. (B) Postoperative radiograph of both hip joints. Anteroposterior view five years after the osteotomy showing preservation of the femoral head contour and joint space. (C) Postoperatively radiograph of both hip joints. Anteroposterior view nine years after the osteotomy showing preservation of the femoral head contour and joint space.
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