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

Abstract

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.

Keywords: Femur head necrosis; Osteotomy.

Fig. 1. Transtrochanteric curved varus osteotomy. (A) Osteonecrosis of femoral head. (B) A curved osteotomy is made between the greater and lesser trochanter, and the femoral head is rotated into a varus position.

Fig. 2. Transtrochanteric rotational osteotomy. (A) The greater trochanter is osteotomized. (B) The femoral head fragment is rotated anteriorly.

Fig. 3. The osteotomies should be performed in medium-size lesions with a combined necrotic angle between 190° and 240°.

Fig. 4. The osteotomies should be performed in type B lesions involving the medial two-thirds or less of the weight-bearing portion according to Japanese Investigation Committee classification.

Fig. 5. Adequate area of viable bone for transtrochanteric rotational osteotomy is an arc (B) of > 120° between the central vertical line of the femoral head and the posterior margin of the necrotic portion on a midsagittal magnetic resonance imaging scan.

Fig. 6. Adequate area of viable bone for transtrochanteric curved varus osteotomy is an arc (A) of > 150° between the central vertical line of the femoral head and the lateral margin of the necrotic portion on the midcoronal magnetic resonance imaging scan.