Sugioka rotational osteotomy in ischemic osteonecrosis of the femoral head
Guenzi F., Valenti J.R., Lacleriga A.
Departamento de Cirugía Ortopédica y Traumatología, Clínica Universitaria, Universidad de Navarra
The treatment of ischemic necrosis of the femoral head depends on the stage and the age of the patient. Sugioka's rotational osteotomy is an alternative between the different conservative techniques. We have used this technique in 12 patient and 13 hips.
The mean age of the patients was 31.8 ranging from 20 to 40. In the first 4 patients we performed the classic technique, as described by Sugioka. In the rest of the patients we used a DHS to stabilize the rotation and a maleolar screw for trochanteric osteotomy. The follow-up ranged between 24 and 67 months, average 42.46 months. The main complications were: 1 embolism, 1 trochanteric pseudoarthrosis and 1 common personal nerve lesion. The radiologic study showed progression in the majority of the cases. Clinical examination was performed following Merle D'Aubigné criteria pre and post surgery. We found 1 excellent result, 3 good, 3 fair and 6 poor (four of them needed a T.H.R.).
Based on our experience, we have suggested a protocol for the treatment of ischemic necrosis of the femoral head. We believe that Sugioka's osteotomy can be indicated in patients younger than 50 and with less than 200 degrees affected (Stage III). The modifications we have made may be useful to achieve a better stabilization of the osteotomy and to improve the postoperative period. We have observed an improvement in the pain and gait in 60% of the patients. The radiologic study showed a progressive deterioration but there was no correlation between the clinical and radiological findings.
Sugioka's technique allows the preservation of the femoral head delaying the total hip replacement.
CITA DEL ARTÍCULO Ann Ital Chir. 1994 Sep-Oct;65(5):583-8; discussion 589