Transtrochanteric Curved Varus Osteotomy Research Articles

Joint-preserving effect and patient-reported outcomes of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head

BackgroundThis study assessed the hip survival rate and patient-reported outcome measures (PROMs) of transtrochanteric curved varus osteotomy (CVO) for osteonecrosis of the femoral head (ONFH) compared with those of conservative management. MethodsThe CVO group comprised 32 consecutive patients (39 hips) who underwent CVO for ONFH between 2000 and 2011. The conservative group consisted of 36 consecutive patients (37 hips) who were managed conservatively for at least 1 year after collapse and who had ONFH classified by the Japanese Investigation Committee of Health and Welfare as type B or C1, for which CVO is indicated. Kaplan–Meier analysis of hip survival used any ONFH-related therapeutic surgery as the endpoint. PROMs were evaluated for all patients with surviving hips and radiographs available at the latest follow-up. ResultThe 10-year hip survival rate in the CVO group was 86.7%, which was significantly higher than the 51.0% 5-year survival rate in the conservative group (p < 0.0001). The Oxford Hip Score and UCLA Activity Score were significantly better in the CVO group without joint space narrowing than in the conservative group, with no significant differences between the CVO group with joint space narrowing and the conservative group. ConclusionCVO could preserve hip joints more effectively than conservative follow-up after collapse, although the presence of joint space narrowing could reduce satisfaction levels even in patients with long-term hip survival.

Anatomic and clinical study of virtual reality technology assisted modified transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head

To explore the feasibility and effectiveness of the modified transtrochanteric curved varus osteotomy in the treatment of osteonecrosis of the femoral head (ONFH), clarify the key points of the operation, and then explore the effectiveness of modified transtrochanteric curved varus osteotomy in the treatment of ONFH assisted by virtual reality (VR) technology. A 70-year-old adult female cadaver without formaldehyde fixation was taken. It was confirmed by anatomical study and simulated operation that the modified transtrochanteric curved varus osteotomy was suitable for type C1 (patients with involvement of the lateral column of the femoral head but partial integrity) classified by the Japanese Osteonecrosis Investigation Committee (JIC). Between October 2018 and August 2020, 11 patients (17 hips) with ONFH who met the selection criteria were treated with modified transtrochanteric curved varus osteotomy. VR technology was used to simulate varus osteotomy before operation to predict the angle of valgus of lower limbs and pronation of femoral head. Osteotomy, valgus, and pronation were performed according to the results of preoperative planning. After operation, X-ray films were used to evaluate the changes of varus and neck-shaft angle after VR assisted surgery, and Harris score was used to evaluate the hip function. The anteroposterior pelvic X-ray film was rechecked at 2 days after operation, of which 3 hips were consistent with the planned varus angle of VR preoperative planning, and the error value of varus angle of the remaining 14 hips was 1°-4°. The difference between VR preoperative planning and 2 days after operation was 6°-16°. All 11 patients were followed up 11-28 months, with an average of 19.2 months. All incisions healed by first intension. During the follow-up, 1 case (1 hip) developed greater trochanter fracture at 2 months after operation and was treated with open reduction and plate and screw internal fixation; 1 case (1 hip) had delayed healing at osteotomy at 4 months after operation and healed at 3 months after local injection of platelet rich plasma and oral supplementation of kidney blood-strengthening soup. At last follow-up, 17 hip osteotomies healed. The Harris score was 84.0±5.6, which was significantly higher than that before operation (57.2±5.5) ( t=-14.107, P=0.000); hip function was excellent in 2 hips, good in 13 hips, and fair in 2 hips. The modified transtrochanteric curved varus osteotomy for the treatment of ONFH is theoretically feasible, and the short-term effectiveness of this operation combined with VR technology is satisfactory.

Femoral Osteotomies for Osteonecrosis of the Femoral Head

Femoral osteotomy is performed for osteonecrosis of the femoral head to prevent the progression of collapse and promote the repair process by transposing the necrotic lesion to the nonweight-bearing portion. The purpose of this review article was to summarize the current knowledge on two types of femoral osteotomy: transtrochanteric anterior or posterior rotational osteotomy and transtrochanteric curved varus osteotomy, both of which are currently performed for osteonecrosis, mainly in Japan and Korea. Osteotomy can be expected to cure osteonecrosis, and no matter how much the durability of artificial joints improves, there will always be young patients for whom the procedure is indicated. We should continue to verify the results of this surgery and refine the techniques involved.

A Finite Element Analysis of Transtrochanteric Curved Varus Osteotomy Combined with Compression Hip Screw System

Background: Complications such as Nonunion, Metal failure and Periprosthetic fracture were found after the TCVO surgery accounting for the mechanical reasons mainly, moreover. There was no any research for simulating TCVO model by using the finite element analysis from the literature. Methods: A TCVO model with 25° fixed with compression hip screw system, which assigned an isotropic heterogeneous material property for the femur was estimated and simulated initial post-operative stage and bone-healing stage, in which the mechanical parameters were compared. Results: (1) The Max displacement in non-friction condition was 9.695 mm. And a strong decrease with the Max displacement of 3.456 mm in condition of bonding for the interfaces. (2) The concentration of von Mises stress on the interfaces were present at the area of lag tunnel with the Max values: 122.0MPa in shaft and 84.20MPa in head, comparing the bone-healing stage, the concentration of von Mises stress in the infero-medial area of contact of the shaft with the Max values: 80.95MPa. (3) The concentration of von Mises stress was both displaced in the junction of osteotomy for the CHS system with the Max von Mises stress values: 1765MPa and 334MPa in two conditions. Conclusions: It was conformed that there was higher instability and fracture risk in the initial post-operative period with more displacement and higher stress in the concentrated point, it was indicated that the load-constrained activities and strong fixation were benefit to decrease the complication and improve the success rate for clinical practice.

The Clinical Result of Transtrochanteric Curved Varus Osteotomy for Idiopathic Osteonecrosis of the Femoral Head

The Clinical Result of Transtrochanteric Curved Varus Osteotomy for Idiopathic Osteonecrosis of the Femoral Head

Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification

To sum up staging treatment experiences of hip preservation for avascular necrosis of the femoral head (ANFH) according to China-Japan Friendship Hospital Classification (CJFH Classification). The literature about hip preservation of ANFH was extensively reviewed, and a staging treatment method for ANFH was set up base on CJFH Classification and the 28 years of clinical experience in this research group. According to CJFH Classification, the ANFH can be rated as types M, C, and L. And the type L is rated as L1, L2, and L3 subtypes. The staging treatment method for ANFH based on CJFH Classification is set up. Conservative treatment was selected for CJFH-M patients because the necrotic area is small and in the medial non-weight-bearing area. Minimally invasive sequestrum clearance, impacting bone graft, and supporting allogenic fibular graft is selected for CJFH-C patients because the necrotic area is also small and in the lateral non-weight-bearing area. If patients are in CJFH-L1, normal bone area is less than 1/3 on hip abduction radiograph, the sequestrum clearance and impacting bone graft via surgical hip dislocation approach can be selected. If patients are in CJFH-L1, normal bone area is more than 1/3 on hip abduction radiograph, the transtrochanteric curved varus osteotomy can be selected. The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is for CJFH-L2 patients. Total hip arthroplasty via direct anterior approach is for CJFH-L3 patients. The staging treatment method for ANFH according to CJFH Classification has good short-term effectiveness. But the long-term effectiveness needs further follow-up.

Value of virtual reality technology in preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of femoral head in adults

To research the value of virtual reality (VR) technology in the preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of the femoral head (ANFH) in adults. Between June 2018 and November 2018, 7 patients (11 hips) with ANFH, who were treated with transtrochanteric curved varus osteotomy, were enrolled in the study. There were 4 males (7 hips) and 3 females (4 hips) with an average age of 31.9 years (range, 14-46 years). Among them, 3 patients were unilateral ANFH and 4 patients were bilateral ANFH. There was 1 patient (1 hip) of traumatic ANFH, 2 patients (4 hips) of alcohol-induced ANFH, 2 patients (3 hips) of hormonal ANFH, and 2 patients (3 hips) of idiopathic ANFH. All hips were Association Research Circulation Osseous (ARCO) stage Ⅲ. There were 5 hips for Japanese Investigation Committee (JIC) type C1 and 6 hips for type C2. There were 5 hips for China-Japan Friendship Hospital (CJFH) type L1,1 for type L2, and 5 for type L3. The disease duration ranged from 5 to 12 months (mean, 8 months). Preoperative Harris score was 53.91±7.66. The neck-shaft angle ranged from 128 to 143° (mean, 133.9°). VR technology was adopted for the preoperative planning. CT data were imported into the software to construct the morphology of necrotic area, and the transrtrochanteric varus osteotomy was simulated. The varus angle was designed according to the integrity rate of femoral head. The planned varus angle was 6 to 16° (mean, 9.7°). The transtrochanteric curved varus osteotomy was performed according to the preoperative planning, and the varus angle and loading area were confirmed under fluoroscopy. If the planned varus angle was too small, it would continue to increase under the fluoroscopy until a satisfactory varus angle. Postoperative changes of the neck-shaft angle were calculated and compared with the preoperative planned varus angle (error). The hip function was assessed by using the Harris score. All incisions healed by first intention. All patients were followed up 6-11 months with an average of 8 months. The X-ray film at 2 days after operation showed that the neck-shaft angle was 112-135° (mean, 123.4°). The difference of the neck-shaft angle between pre- and post-operation was 6-16° (mean, 11.0°). Among them, the difference of the neck-shaft angle was consistent with planned varus angle in 5 hips, while the error of the remaining 6 hips was 1-4°. There was 1 patient (1 hip) of osteotomy nonunion at 4 months after operation, 1 patient (1 hip) of proximal femur fracture at 2 months after operation. The rest 5 patients (9 hips) obtained union at the osteotomy. At last follow-up, the Harris score was 82.18±16.35, showing significant difference when compared with preoperative score ( t=-5.195, P=0.000). VR technology is a brand-new preoperative planning method for transtrochanteric curved varus osteotomy in treating ANFH.

Effects of anterior boundary of the necrotic lesion on the progressive collapse after varus osteotomy for osteonecrosis of the femoral head

BackgroundAnterior localization of the necrotic lesion was recently proposed as an important factor for the occurrence of collapse even in medially located osteonecrosis of the femoral head (ONFH). We examined the effects of the anterior boundary of the necrotic lesion on progressive collapse after varus osteotomy for ONFH. MethodsWe reviewed the outcomes of 31 hips in 27 patients with ONFH treated by transtrochanteric curved varus osteotomy (CVO) from 2000 to 2012 with a mean follow-up of 10.5 years. The occurrence of progressive collapse of the anterior necrotic lesion was defined as the presence of ≥2 mm collapse using follow-up lateral radiographs. Postoperative osteoarthritic change was defined as ≥1 mm progression of joint space narrowing on follow-up radiographs. The location of the anterior boundary of the necrotic lesion was assessed using the anterior necrotic angle (the angle between the midline of the femoral neck shaft and the line passing from the femoral head center to the anterior boundary of the necrotic lesion on a mid-slice oblique magnetic resonance image). ResultsAll hips had a postoperative intact ratio of ≥34% (percentage of the transposed intact articular surface of the femoral head to the weight-bearing area of the acetabulum after femoral osteotomy). Progressive collapse of the anterior necrotic lesion was seen in five hips (16%) during a mean of 2.2 years after CVO. Of these, four hips (80%) proceeded to develop osteoarthritic change at an average of 4.3 years after the collapse. Multivariate analysis revealed that the anterior necrotic angle was independently associated with progressive collapse of the anterior necrotic lesion as well as the postoperative intact ratio. ConclusionsThis study suggests that hips with anterior localization of the necrotic lesion have a possible risk of progressive collapse of the anterior necrotic lesion after CVO, which can frequently lead to subsequent osteoarthritic change.

Which Osteotomy for Osteonecrosis of the Femoral Head and Which Patient for the Osteotomy?

Transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) are joint-preserving procedures for osteonecrosis of the femoral head. The purpose of this review is to provide up-to-date guidelines for the osteotomies. One retrospective comparison revealed that TCVO has shorter operation time, less bleeding, lower incidence of osteophyte formation, and lower rate of secondary collapse. To obtain successful results of the osteotomy, the patient should be younger than 40 years and should have a body mass index of less than 24 kg/m2. The osteotomy should be performed in early stages of femoral head osteonecrosis before marked collapse of the femoral head. The patient should have a medium-size lesion and an enough viable bone to restore the intact articular surface and subchondral bone in the weight-bearing area.

Subchondral insufficiency fracture of the femoral head: a report of two cases with a history of internal fixation of a femoral neck fracture

We report our experience in two cases of subchondral insufficiency fracture of the femoral head with a history of internal fixation of the femoral neck fracture. Both cases were young females (26 and 43 years old, respectively). Their hip pain occurred more than 2 years and 1 year after the primary surgical treatment, respectively. MRI revealed bone marrow edema pattern, as well as a low-intensity band on the T1-weighted images, which are commonly observed in osteonecrosis. However, the low-intensity bands were parallel to the subchondral bone end-plate, which are characteristic findings of subchondral insufficiency fracture. Both patients were administered anti-inflammatory drugs and/or bisphosphonate. One patient underwent a transtrochanteric curved varus osteotomy 1 year and 9 months after the onset, and the other healed without collapse of the femoral head. Our cases indicate that subchondral insufficiency fractures may need to be considered as one of the possible conditions after the internal fixation of a femoral neck fracture, in addition to posttraumatic osteonecrosis.

The Clinical Results of a Modified Transtrochanteric Curved Varus Osteotomy for Osteonecrosis of the Femoral Head

The Clinical Results of a Modified Transtrochanteric Curved Varus Osteotomy for Osteonecrosis of the Femoral Head

Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years

We investigated the factors related to the radiological outcome of a transtrochanteric curved varus osteotomy in patients with osteonecrosis of the hip. We reviewed 73 hips in 62 patients with a mean follow-up of 12.4 years (5 to 31.1). There were 28 men and 34 women, with a mean age of 33.3 years (15 to 68) at the time of surgery. The 73 hips were divided into two groups according to their radiological findings: group 1 showed progression of collapse and/or joint-space narrowing; group 2 had neither progressive collapse nor joint-space narrowing. Both of these factors and the radiological outcomes were analysed by a stepwise discriminant analysis. A total of 12 hips were categorised as group 1 and 61 as group 2. Both the post-operative intact ratio and the localisation of the necrotic lesion correlated with the radiological outcome. The cut-off point of the postoperative intact ratio to prevent the progression of collapse was 33.6%, and the cut-off point to prevent both the progression of collapse and joint-space narrowing was 41.9%. The results of this study indicate that a post-operative intact ratio of 33.0% is necessary if a satisfactory outcome is to be achieved after this varus osteotomy.

Leg-length discrepancy after transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head

Transtrochanteric curved varus osteotomy was designed to avoid some of the disadvantages of varus wedge osteotomy, such as post-operative leg-length discrepancy. In this retrospective study we investigated the leg-length discrepancy and clinical outcome after transtrochanteric curved varus osteotomy undertaken in patients with osteonecrosis of the femoral head. Between January 1993 and March 2004, this osteotomy was performed in 42 hips of 36 patients with osteonecrosis of the femoral head. There were 15 males and 21 females with a mean age at surgery of 34 years (15 to 68). The mean follow-up was 5.9 years (2.0 to 12.5). The mean pre-operative Harris hip score was 64.0 (43 to 85) points, which improved to a mean of 88.7 (58 to 100) points at final follow-up. The mean varus angulation post-operatively was 25 degrees (12 degrees to 38 degrees ) and the post-operative mean leg-length discrepancy was 13 mm (4 to 25). The post-operative leg-length discrepancy showed a strong correlation with varus angulation (Pearson's correlation coefficient; r = 0.9530, p < 0.0001), which may be useful for predicting the leg-length discrepancy which can occur even after transtrochanteric curved varus osteotomy.

寛骨臼回転骨切り術とキアリー骨盤骨切り術＋大腿骨内反骨切り術の短期成績の比較

We compared the short-term post-operative results of rotational acetabular osteotomy (group of RAO) and Chiari pelvic osteotomy with Transtrochanteric curved varus osteotomy (group of Chiari varus) in the treatment of the osteoarthritic hip joint. Assessment was made at 4 weeks, 12 weeks, 6 months and 1 year after surgery to compare the influence of operative technigue on, ROM, MMT, time to start walking hospitalisation, JOA score and radiographic evaluation. In regard to the amount of blood loss the Chiari varus group was superior to the RAO group. Regarding MMT, time to start walking hospitalisation and radiographic evaluation the RAO group was superior to the Chiari varus group.

変形性股関節症に対する転子間わん曲内反骨切り術の成績

In 1969 Nishio devised transtrochanteric curved varus osteotomy in the treatment of subluxation of the hip. We performed this procedure on 50 hips in 46 patients from 1976 through 1987 at our hospital. We studied 34 hips in 30 patients in these patients which were followed for more than 2 years.Radiological results showed that 19 hips were good. 12 hips were poor and other 3 hips had little change. Poor group in radiological results did not remark improvement of pain score in clinical results. 3 hips showed femoral head necrosis and another 3 hips showed lateral subluxation of the head. This procedure has been useful to early stage of osteoarthritis with subluxation of the hip, especially unilateral type.