CORRECTIVE OSTEOTOMY FOR OSTEONECROSIS OF THE FEMORAL-HEAD - THE RESULTS OF A LONG-TERM FOLLOW-UP-STUDY

We reviewed the long-term results of thirty-seven corrective osteotomi es that had been performed for osteonecrosis of the femoral head that was stage II or III according to the classification of Ficat and Arlet . At a mean of 11.5 years (range, five to eighteen years) postoperativ ely, twenty-eight hips (76 per cent) had a good or excellent result ac cording to the Harris hip-scoring system, and nine (24 per cent) had a fair or poor result and subsequently needed a total hip arthroplasty. Six of the nine failures were in the seventeen hips of patients who h ad received corticosteroids. Conversely, of the twenty hips of patient s who had not received corticosteroids, seventeen (85 per cent) had a good or excellent result as determined by the Harris hip score at the latest follow-up evaluation. Five of the six hips that had had a combi ned necrotic angle of more than 200 degrees preoperatively had subsequ ent collapse of the femoral head. Of the thirty-one hips that had had a combined necrotic angle of less than 200 degrees preoperatively, twe nty-seven (87 per cent) had a good or excellent clinical result. There were five complications. Three non-unions and one cutout of the compr ession screw were successfully treated, and these hips had an excellen t clinical result at the time of the latest follow-up. The fifth compl ication was osteomyelitis and led to a poor result. The results of thi s study suggest that corrective intertrochanteric osteotomy is a succe ssful treatment for Ficat and Arlet stage-II or III disease if the pat ient has a small or medium lesion (a combined necrotic angle of less t han 200 degrees) and is not receiving continuous high doses of cortico steroids.