Clin Orthop Surg.  2017 Mar;9(1):29-36. 10.4055/cios.2017.9.1.29.

Healing Process of Osteonecrotic Lesions of the Femoral Head Following Transtrochanteric Rotational Osteotomy: A Computed Tomography-Based Study

• Lakhotia D
• Swaminathan S
• Shon WY
• Oh JK
• Moon JG
• Dwivedi C
• Hong SJ

• KMID: 2412300
• DOI: http://doi.org/10.4055/cios.2017.9.1.29

Abstract

BACKGROUND
Transtrochanteric rotational osteotomy (TRO) is a controversial hip-preserving procedure with a variable success rate. The healing process of femoral head osteonecrosis after TRO has been poorly explained till now. This study aimed to evaluate the healing process of previously transposed necrotic lesion after a TRO for nontraumatic osteonecrosis of the femoral head using computed tomography (CT).
METHODS
Among 52 patients (58 hips) who had preserved original femoral head after TRO, we retrospectively reviewed 27 patients (28 hips) who had undergone sequential CT scans and had no major complication following TRO. The average age was 34 years (range, 18 to 59 years). The mean follow-up period was 9.1 years. We evaluated the reparative process of the transposed osteonecrotic lesion with CT scans.
RESULTS
Plain radiographs of the osteonecrotic lesion revealed sclerotic and lucent changes in 14 hips (50%) and normal bony architecture in the other 14 hips (50%) at the final follow-up. CT scans of the osteonecrotic lesions showed cystic changes with heterogeneous sclerosis in 13 hips (46%), normal trabecular bone with or without small cysts in 9 hips (32%), and fragmentation of the necrotic lesion in 6 hips (22%). Seventeen hips (60%) showed minimal (13 hips) to mild (4 hips) nonprogressive collapse of the transposed osteonecrotic area. The collapse of the transposed osteonecrotic area on the CT scan was significantly associated with the healing pattern (p = 0.009), as all 6 patients (6 hips) with fragmentation of the necrotic lesion had minimal (5 hips) to mild (1 hip) collapse. Furthermore, a significant association was found between the collapse of the transposed osteonecrotic area on the CT scan of 17 hips (60%) and postoperative Harris hip score (p = 0.021). We observed no differences among the healing patterns on CT scans with regard to age, gender, etiology, staging, preoperative lesion type, preoperative intact area, percentage of necrotic area, direction of rotation and immediate postoperative intact area.
CONCLUSIONS
The majority of the hips showed incomplete regeneration of the transposed osteonecrotic lesion with cysts, sclerosis, and fragmentation, whereas repair with normal trabecular bone was observed only in one-third of the hips that were preserved after Sugioka TRO.

Keyword

Femur head necrosis; Osteotomy; Repair; Computed tomography

MeSH Terms

Adolescent
Adult
*Bone Regeneration
Female
Femur Head/*physiology
Femur Head Necrosis/*diagnostic imaging/*physiopathology/surgery
Follow-Up Studies
Humans
Male
Middle Aged
Osteotomy/*methods
Retrospective Studies
Tomography, X-Ray Computed
*Wound Healing
Young Adult

Figure

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  Fig. 1 Sequential plain anteroposterior radiographs (A–D), coronal computed tomography (CT) scans (E–H), and sagittal CT scans (I–L) of a 52-year-old man with 9 years of follow-up after anterior transtrochanteric rotational osteotomy showing a cyst and irregular osteosclerotic areas. (A, E, I) Postoperative radiograph and CT scans taken at 2-year follow-up. (B, F, J) Postoperative radiograph and CT scans taken at 4-year follow-up. (C, G, K) Postoperative radiograph and CT scans taken at 6-year follow-up. (D, H, L) Postoperative radiograph and CT scans taken at 9-year follow-up.

• 

  Fig. 2 Sequential plain anteroposterior radiographs (A–C) and computed tomography (CT) scans (D–F) of a 33-year-old female with 10 years of follow-up after posterior transtrochanteric rotational osteotomy showing normal bony architecture without cyst. (A, D) Postoperative radiograph and CT scan taken at 1.5-year follow-up. (B, E) Postoperative radiograph and CT scan taken at 4-year follow-up. (C, F) Postoperative radiograph and CT scan taken at 9-year follow-up.

• 

  Fig. 3 Sequential plain anteroposterior radiographs (A–D) and computed tomography (CT) scans (E–H) of a 43-year-old male with 9 years of follow-up after posterior transtrochanteric rotational osteotomy showing fragmentation of the necrotic lesion. (A, E) Postoperative radiograph and CT scan taken at 2-year follow-up. (B, F) Postoperative radiograph and CT scan taken at 4-year follow-up. (C, G) Postoperative radiograph and CT scan taken at 6-year follow-up. (D, H) Postoperative radiograph and CT scan taken at 9-year follow-up.

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