Rotational osteotomy on the base of femoral neck in treating osteonecrosis of the femoral head / 中华骨科杂志

ABSTRACT

Objective To report the short-term outcomes of the rotational osteotomy on the base of femoral neck in treating osteonecrosis of femoral head.Methods Ten patients (10 hips) with osteonecrosis of femoral head underwent the rotational osteotomy on the base of femoral neck between March 2014 and October 2016.There were 9 males and 1 female.The average age was 29.6 years,ranging from 18 to 42 years.There were 4 patients in right side and 6 in left side.The Association Research Circulation Osseous (ARCO) Stage was from ⅡB to ⅢC (2 cases of ⅡB,2 cases of ⅡC,1 case of ⅢA,1 case of ⅢB,4 cases of ⅢC).The following main procedures were involved in the treatment:surgical hip dislocation,the extension of retinacular soft-tissue flap to protect the main blood supply of the femoral head,anterior or posterior rotational (60°-90°) of femoral head after femoral neck osteotomy.We used three compress cannulated screws to fix the femoral neck osteotomy.The postoperative Harris hip scores (HHS),Western Ontario and McMaster College (WOMAC) score,pelvic A-P view and lateral hip view radiographic characteristics were analyzed to assess the short-term outcomes.Results The average follow-up duration was 16.3 months (7-36 months).No progressive femoral head collapse was observed in 6 patients at the last follow-up.The average post-operative intact ratio was 42.90％± 10.07％.The HHS improved from 80.00±14.93 to 86.83±6.11 (4 cases improved,1 case with no change and 1 case decreased slighdy).The WOMAC score decreased from 16.00±14.53 to 9.00±3.85 (1 cases increased,1 case with no change and 4 case decreased).The remaining 4 cases,however,had the progression of the femoral head collapse.The average post-operative intact ratio was 16.57％±6.57％.The HHS decreased from 77.75±14.66 to 60.75±17.54 (1 case improved slightly and 3 cases decreased).The WOMAC score increased from 12.75±5.06 to 22.50±8.81 (4 cases increased).Conclusion The rotational osteotomy on the base of femoral neck not only shifts the necrosis area away from weight-bearing region but also improves the post-operative intact ratio.Patients with ARCO stage ⅡB-ⅢB may achieve remission of symptoms and improvement of hip function by this surgical technique.However,for patients with ⅢC stage,we should conduct preoperative design to make sure whether the surgery is worth doing or not.Some patients may suffer from post-operative progression collapse of the femoral head.