Intertrochanteric flexion osteotomy and total hip arthroplasty for osteonecrosis of the femoral head - A comparative retrospective study

Intertrochanteric flexion osteotomy and total hip arthroplasty are the most frequent operative treatments of advanced osteonecrosis of the femoral head in adults. In a retrospective study the postoperative results of intertrochanteric osteotomy and total hip arthroplasty were determined in 68 cases. The evaluation was based on the modified Harris-Hip-Score, the clinical examination and the radiological classification of the ARCO. The patients after osteotomy showed significantly worse subjective results. After osteotomy an increase of the stage of osteonecrosis was found in 73% of the patients. There was no correlation between clinical result and radiological stage of osteonecrosis. In spite of a better preoperative situation the results after osteotomy compared to hip arthroplasty were disappointing in many cases. The postoperative result did not depend on the preoperative stage of the osteonecrosis. The new classification system of the ARCO, which includes the very important MRI, proved to be very suitable and practicable. Based on our results it seems to be reasonable, to restrict the indication for intertrochanteric flexion osteotomy to cases of low stage osteonecrosis and carry out cementless total hip arthroplasty primarily in all others.