Transtrochanteric rotational osteotomy, section after Sugioka.

BACKGROUND: Femoral caput necrosis is an actual therapeutic problem, because it appears mainly in mid-aged people. The necrotic focus is most often localized in the proximal and ventral parts of the femoral bone capitulum, which, from the biomechanical point of view is the most loaded part. These cases can be possibly treated by transtrochanteric rotational osteotomy. By means of this operation we rotate the necrotic focus to the less loaded part of the joint in correlation with the acetabulum.

PURPOSE: The aim of this paper is to inform about a rarely performed operation after Sugioka: transtrochanteric rotational osteotomy in coincidence with avascular necrosis of the femoral bone caput. We would like to point to the possibility of a joint-saving operation, which enables to postpone implantation of total endoprosthesis to older age.

METHODS: We analyzed the operational therapy performed at our department in the period 1998-2000, focusing especially on joint-saving operations due to femoral caput necrosis. We turned our attention to transtrochanteric rotational osteotomy after Sugioka. In four casuistics, we describe the results of these operations.

RESULTS: Transtrochanteric rotational osteotomy was performed in 12 patients. The treatment is described in four casuistics. The results after 1-3 years are good. The illness has not progressed in any of patients, pain has regressed, mobility improved and it was not necessary to implant total endoprosthesis.

CONCLUSION: We consider the transtrochanteric rotational osteootomy, section after Sugioka, as one of the possible treatments in mid-aged patients. Our effort is to perform joint-saving operations in order to postpone the implantation of total endoprosthesis. (Fig. 10, Ref. 13.)