Transtrochanteric Rotational Osteotomy in the Treatment of Idiopathic and Steroid-induced Femoral Head Necrosis, Perthes?? Disease, Slipped Capital Femoral Epiphysis, and Osteoarthritis of the Hip

Abstract

Transtrochanteric rotational osteotomies were successful in 342 hips (274 patients) for the treatment of idiopathic and steroid-induced osteonecrosis of the femoral head, Perthes' disease, slipped capital femoral epiphysis, osteoarthritis, and other disorders. One hundred fifty-eight hips (113 patients) with idiopathic and steroid-induced necrosis were followed up for two to 11 years. In 121 of 158 hips, excellent results were obtained clinically and roentgenographically. In 42 Grade I or II hips, excellent results were obtained in every respect (success rate, 86%). Eighty-eight of 93 hips in which the intact surface was greater than one-third of the total on lateral roentgenograms obtained prior to surgery showed no collapse of the newly created weight-bearing area (success rate, 95%). Ninety-eight of the 102 hips in which the ratio of the intact area of the femoral head to the acetabular weight-bearing area on postoperative anteroposterior roentgenograms was greater than 36% showed no further collapse. These results suggest that adequate rotation is essential. Intentional varus positioning should be designed for patients with advanced collapse and extensive lesions. In the case of Perthes' disease all seven hips showed excellent results, and repair processes were completed within one year. In the treatment of slipped epiphysis anterior rotational osteotomies were performed in ten hips (10 patients); nine of the ten hips showed excellent results, with perfect correction of the deformity. Twenty-two patients with osteoarthritis were treated by rotational osteotomy. Ten of these patients were followed up for two to nine years; nine of ten showed excellent results. In only one hip with a severely dysplastic acetabulum was there a recurrence of pain and narrowing of joint space. These results suggest that this procedure may be used not only for femoral head necrosis but for patients with Perthes' disease, slipped capital epiphysis, and osteoarthritis of the hip as well.