Curved Intertrochanteric Varus Osteotomy vs Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients Under 50 Years Old.

Abstract

BACKGROUND:

Given recent advances in total hip arthroplasty (THA), curved intertrochanteric varus osteotomy (CVO) is not indicated as a treatment for osteonecrosis of the femoral head (ONFH), unless indicated to maintain long-term hip function and achieve patient satisfaction. We aimed to compare the clinical outcomes of CVO with those of THA for treatment of ONFH in young adults <50 years old.

METHODS:

This comparative study included 105 ONFH patients: 59 patients (65 hips) who underwent CVO and 46 patients (56 hips) who underwent THA. Assessment tools included the Harris hip score (HHS), patient-reported outcomes of the Short Form-36, Oxford hip score, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire, and University of California, Los Angeles score, together with complication and survival rates.

RESULTS:

Preoperative HHS was significantly higher in the CVO group than in the THA group (P < .01). At the last follow-up, no between-group differences were noted in HHS, all domains of Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire scores, Oxford hip score, and Short Form-36. University of California, Los Angeles scores and complication rates were comparable: 3% for the CVO and 7% for the THA group. The 10-year survival rate with surgery for any reason as the end point was comparable, at 91.8% for the CVO and 97.7% for the THA group.

CONCLUSION:

Functional outcomes, survival rate, and sporting activities for patients <50 years old undergoing CVO or THA for ONFH were comparable after a mean follow-up period of 10 years. Strict indications for CVO can help maintain hip function and patient satisfaction equivalent to that for THA, in the long term.

• Authors: Yusuke Osawa, Taisuke Seki, Toshiaki Okura, Yasuhiko Takegami, Naoki Ishiguro, Yukiharu Hasegawa
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 35 Issue 6 Pg. 1600-1605 (06 2020) ISSN: 1532-8406 [Electronic] United States
• PMID: 32063410 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Arthroplasty, Replacement, Hip (adverse effects)
• Femur Head (surgery)
• Femur Head Necrosis (surgery)
• Humans
• Los Angeles
• Middle Aged
• Osteotomy
• Retrospective Studies
• Treatment Outcome
• Young Adult