Effect of Trochanter Displacement on Impingement and Bone Contact in Total Hip Arthroplasty Performed After Curved Intertrochanteric Varus Osteotomy for Osteonecrosis of the Femoral Head: a Simulation Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2022 Sep 8

PMID 36076229

Authors

Masanori Okamoto

Taisuke Seki

Yasuhiko Takegami

Yusuke Osawa

Shiro Imagama

Affiliations

Soon will be listed here.

Abstract

Background: Curved intertrochanteric varus osteotomy (CVO) is a useful treatment option for osteonecrosis of the femoral head (ONFH). However, the effect of proximal femoral deformity in cases of CVO converted to total hip arthroplasty (THA) remains unclear. The aim of this study was to evaluate the effect of trochanter displacement on impingement and the contact state of the implant and femur in THA.

Methods: Thirty-eight hips that had undergone CVO for ONFH were reviewed and compared with a control group of 30 contralateral hips that had not undergone surgery. The range of motion (ROM) and impingement patterns and the percentage of cortical bone in the stem placement within the femur were measured by simulation using CT-based three-dimensional template software. We also measured the ROM and the number of joints that achieved the ROM required for activities of daily living when the upward displaced apex of the greater trochanter with osteotomy was resected and compared the findings with those obtained when the apex was not resected.

Results: The CVO group showed a significantly greater bony impingement in external rotation (68.4% vs. 43.3%, p = 0.033) and abduction (78.9% vs. 33.3%, p < 0.001) than in the control group. The CVO group showed a significantly smaller range of external rotation (19.0° [interquartile range; 4.0-28.8] vs. 38.0° [interquartile range; 36.0-41.8], p < 0.001) and abduction (23.0° [interquartile range; 8.5-38.8] vs. 56.0° [interquartile range; 50.3-60.0], p < 0.001) than in the control group. Significantly more joints achieved the ROM necessary for activities of daily living when the apex was resected than when it was not (10.5% vs. 63.2%, p < 0.001). The percentage of cortical bone in the stem placement position was significantly higher in the CVO group than in the control group in the proximal portion of the stem (25.5% vs. 0.0%, p < 0.001).

Conclusion: In cases requiring conversion to THA, we recommend resecting the upward displaced apex to achieve a sufficient ROM and carefully resecting the bone to avoid malignment of the stem.

Citing Articles

Digital Templating of Hip Arthroplasty Using Microsoft PowerPoint: A Pilot Study with Technical Details.

Cha Y, Chung J, Kim J, Yoo J, Lee W, Kim J Bioengineering (Basel). 2024; 11(4).

PMID: 38671749 PMC: 11048024. DOI: 10.3390/bioengineering11040327.

References

Sugioka Y . Transtrochanteric rotational osteotomy in the treatment of idiopathic and steroid-induced femoral head necrosis, Perthes' disease, slipped capital femoral epiphysis, and osteoarthritis of the hip. Indications and results. Clin Orthop Relat Res. 1984; (184):12-23. View

Osawa Y, Seki T, Takegami Y, Kusano T, Makida K, Ishiguro N . Cementless total hip arthroplasty for osteonecrosis and osteoarthritis produce similar results at ten years follow-up when matched for age and gender. Int Orthop. 2018; 42(7):1683-1688. DOI: 10.1007/s00264-018-3987-7. View

Osawa Y, Seki T, Okura T, Takegami Y, Ishiguro N, Hasegawa Y . Curved Intertrochanteric Varus Osteotomy vs Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients Under 50 Years Old. J Arthroplasty. 2020; 35(6):1600-1605. DOI: 10.1016/j.arth.2020.01.026. View

Park K, Tumin M, Peni I, Yoon T . Conversion total hip arthroplasty after previous transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Arthroplasty. 2013; 29(4):813-6. DOI: 10.1016/j.arth.2013.09.012. View

Zhao G, Yamamoto T, Ikemura S, Motomura G, Mawatari T, Nakashima Y . Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg Br. 2010; 92(6):781-6. DOI: 10.1302/0301-620X.92B6.23621. View

Kim Y, Kim J, Park J, Joo J . Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report. J Bone Joint Surg Am. 2011; 93(19):1806-10. DOI: 10.2106/JBJS.J.01312. View

Issa K, Pivec R, Kapadia B, Banerjee S, Mont M . Osteonecrosis of the femoral head: the total hip replacement solution. Bone Joint J. 2013; 95-B(11 Suppl A):46-50. DOI: 10.1302/0301-620X.95B11.32644. View

Osawa Y, Seki T, Morita D, Takegami Y, Okura T, Ishiguro N . Total Hip Arthroplasty After Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head: A Mean 10-Year Follow-Up. J Arthroplasty. 2017; 32(10):3088-3092. DOI: 10.1016/j.arth.2017.05.020. View

Utsunomiya T, Motomura G, Ikemura S, Hamai S, Fukushi J, Nakashima Y . The Results of Total Hip Arthroplasty After Sugioka Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis. J Arthroplasty. 2017; 32(9):2768-2773. DOI: 10.1016/j.arth.2017.04.034. View

10.

Sugioka Y, Hotokebuchi T, Tsutsui H . Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res. 1992; (277):111-20. View

11.

Sakano S, Hasegawa Y, Torii Y, Kawasaki M, Ishiguro N . Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004; 86(3):359-65. DOI: 10.1302/0301-620x.86b3.14383. View

12.

Sonohata M, Kitajima M, Kawano S, Mawatari M . Comparison of Total Hip Arthroplasty Outcomes after Failed Femoral Wedge or Curved Varus Osteotomy. Open Orthop J. 2018; 12:208-217. PMC: 6018131. DOI: 10.2174/1874325001812010208. View

13.

Takegami Y, Komatsu D, Seki T, Ishiguro N, Hasegawa Y . Total hip arthroplasty after failed curved intertrochanteric varus osteotomy for avascular necrosis of the femoral head. Nagoya J Med Sci. 2016; 78(1):89-97. PMC: 4767517. View

14.

Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D . ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002; 35(4):543-8. DOI: 10.1016/s0021-9290(01)00222-6. View

15.

Hasegawa Y, Sakano S, Iwase T, Iwasada S, Torii S, Iwata H . Pedicle bone grafting versus transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg Br. 2003; 85(2):191-8. DOI: 10.1302/0301-620x.85b2.13190. View

16.

Inoue D, Kabata T, Maeda T, Kajino Y, Yamamoto T, Takagi T . The correlation between clinical radiological outcome and contact state of implant and femur using three-dimensional templating software in cementless total hip arthroplasty. Eur J Orthop Surg Traumatol. 2016; 26(6):591-8. DOI: 10.1007/s00590-016-1796-5. View

17.

Okura T, Hasegawa Y, Morita D, Osawa Y, Ishiguro N . What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head?. Arch Orthop Trauma Surg. 2016; 136(12):1647-1655. DOI: 10.1007/s00402-016-2563-0. View

18.

Hemmerich A, Brown H, Smith S, Marthandam S, Wyss U . Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res. 2006; 24(4):770-81. DOI: 10.1002/jor.20114. View

19.

Gruen T, McNeice G, Amstutz H . "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141):17-27. View

20.

Seki T, Hasegawa Y, Masui T, Yamaguchi J, Kanoh T, Ishiguro N . Quality of life following femoral osteotomy and total hip arthroplasty for nontraumatic osteonecrosis of the femoral head. J Orthop Sci. 2008; 13(2):116-21. DOI: 10.1007/s00776-007-1208-0. View