Background: While rotational acetabular osteotomy has been reported
to be successful for the treatment of osteoarthritis of the dysplastic hip,
little is known about its efficacy in the treatment of osteonecrosis of the
femoral head.
Methods: We retrospectively reviewed the results for a consecutive
series of twenty-one patients (twenty-five hips) who had undergone rotational
acetabular osteotomy between 1995 and 2001 for the treatment of extensive
osteonecrosis of the femoral head associated with collapse. All but two of the
patients had a history of steroid therapy as part of a treatment regimen for
various diseases. At the time of surgery, the mean age of the five men and
sixteen women was 29.0 years. The mean duration of follow-up was forty-nine
months. No patient was lost to follow-up. The lesions were classified
according to the staging system described by Steinberg et al., and the extent
of necrosis was measured with use of the criteria described by Kerboul et al.
Clinical evaluation was performed with use of the scoring system of Merle
d'Aubigné and Postel. Radiographic evaluation was performed with use of
yearly serial anteroposterior and lateral plain radiographs.
Results: The mean Merle d'Aubigné and Postel score improved
from 11.3 points preoperatively to 14.9 points at the time of the final
follow-up (p < 0.001). The mean pain score improved from 3.0 to 5.6 points
(p < 0.001). However, the mean mobility score was 5.3 points preoperatively
but only 4.9 points postoperatively (p = 0.1). All of the osteotomy sites
showed radiographic evidence of osseous union at the time of the latest
follow-up. Collapse of the femoral head progressed in seven hips, but in six
of these hips the change in the extent of collapse was <2 mm.
Conclusions: In the present study of young patients with extensive
osteonecrosis and collapse of the femoral head, rotational acetabular
osteotomy was associated with symptomatic relief and absence of substantial
collapse of the femoral head at the time of early to intermediate-term
follow-up.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.