Introduction

Once collapse occurs at the necrosis area of the femoral head, it usually progresses. Collapse causes incongruity and instability of the hip joint, and the progression of collapse causes incongruity and instability to increase and finally results in secondary osteoarthritis (Fig. 1). The purpose of osteotomy for osteonecrosis of the femoral head (ONFH) is to prevent the progression of collapse and secondary osteoarthritis. A principle of osteotomy is to support weight-bearing with intact or live bone instead

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

Fig. 1. Natural course of osteonecrosis of the femoral head (ONFH)
Fig. 2. A principle of anterior rotational osteotomy for ONFH. The dashed line shows the osteonecrosis area of the femoral head from the anterior view

of the necrotic bone and to restore the subluxated femoral head (Fig. 2). In other words, osteotomy is on-site vascularized bone grafting with articular cartilage and with good congruency. Options of osteotomy for ONFH are transtrochanteric anterior or posterior rotational osteotomy (ARO or PRO) developed by Sugioka et al. [1,2], and intertrochanteric curved varus osteotomy developed by Nishio and Sugioka [3]. The treatment option is chosen depending on the lesion of osteonecrosis or on where and how wide is the osteonecrosis area in the femoral head. Stage and age at the operation are also considered in this choice.

Many young patients suffer from the disease. Especially for young patients, osteotomy is an important treatment option to be considered, and they are expected to survive for a long time after their hip osteotomy. Osteotomy in Kyushu University Hospital started in 1972. Sugioka developed transtrochanteric rotational osteotomy

Fig. 3. Sequential photographs of anterior rotation of the femoral head show a model of anterior rotational osteotomy (ARO) with 20° varus position and indicate how ARO results in weight-bearing with the living posterior surface of the femoral head (a-f). Hatched area indicates necrotic area. All the photographs show the anterior view. According to anterior rotation, the osteotomy line is 10° inclination away from the perpendicular to the neck (a) and 10° retroversion. The result is 20° varus position after anterior rotation of the femoral head (f)

Fig. 3. Sequential photographs of anterior rotation of the femoral head show a model of anterior rotational osteotomy (ARO) with 20° varus position and indicate how ARO results in weight-bearing with the living posterior surface of the femoral head (a-f). Hatched area indicates necrotic area. All the photographs show the anterior view. According to anterior rotation, the osteotomy line is 10° inclination away from the perpendicular to the neck (a) and 10° retroversion. The result is 20° varus position after anterior rotation of the femoral head (f)

of the femoral head, so-called "rotational osteotomy" or "Sugioka's osteotomy" [1]. Anterior rotation of the femoral head with vascularity results in weight-bearing with the live posterior surface of the femoral head (Fig. 3).

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