Long-term results of transtrochanteric rotational osteotomy for femoral head osteonecrosis

Twenty transtrochanteric rotational osteotomies were performed in 19 patients with osteonecrosis of the femoral head (average age 32 years; range 19-55 years). There were 17 hips at Ficat stage III and three at stage IV. The average head rotation achieved was 70 degrees (range 55 degrees-95 degrees). Fourteen hips were converted to a total hip arthroplasty after an average period of 5.6 years (range 1.5-12.7 years). Five hips have maintained a good clinical result and normal function for an average period of 11.3 years (range 9.2-13.5 years). One patient with an ankylosed hip was lost to follow-up at 3.5 years. All hips with incomplete rotation of the necrotic fragment out of the weight-bearing area were revised to total hip arthroplasties. All unrevised hips had radiographic evidence of mild to moderate osteoarthritis. Total hip arthroplasty was deferred for a modest period in most patients, and conversion was performed without difficulty. However, we no longer advocate transtrochanteric rotational osteotomy because of unpredictable results and technical difficulties, especially with large lesions.