A modified transtrochanteric rotational osteotomy for osteonecrosis of the femoral head

The aim of this study is to report the clinical results of modified transtrochanteric osteotomy in osteonecrosis of the femoral head. The authors used a modified transtrochanteric osteotomy for rotational osteotomy in which the greater trochanter is not detached. In 82 cases (75 patients), the mean age was 33 years; 14 were classified as Ficat stage 2, 55 as stage 3, and 13 as Ficat stage 4. We performed simple modified rotational osteotomy in 16 cases, a combination of osteotomy and simple bone grafting in 7, and a combination of osteotomy and muscle pedicle bone grafting in 59 cases. Postoperative evaluation utilized radiographic findings and the Harris hip score. Five patients underwent total hip arthroplasty. Among the 77 surviving cases, excellent results were obtained in 47 hips, good in 22, fair in 5, and poor in 3. Including 3 cases that were classed as poor, overall survival rate was 90%. Using modified transtrochanteric rotational osteotomy, we were able to obtain satisfactory results. Although this technique is difficult to perform, it is recommended particularly for young patients with stage 2 or 3 and some selected patients with stage 4.