Results of transtrochanteric rotational osteotomy for femoral head osteonecrosis.

Eighteen transtrochanteric rotational osteotomies have been performed in 17 patients for femoral head osteonecrosis (15 patients, Ficat Stage III disease; three patients, Ficat Stage IV disease) during a 51-month period and have 18 to 63 months of follow-up study. The best results were in the posttraumatic and nonsteroid-associated idiopathic cases in patients with small necrotic segments in the weight-bearing region, with no degenerative changes. Failures occurred in patients with large necrotic fragments, preexisting degenerative changes, and steroid- and alcohol-associated etiologies. Although joint arthroplasty was eventually required in ten hips, a period of temporization was achieved sufficient to bring them into the era of cementless hip arthroplasties. Indications for this operation should be restricted to those patients under 40 years of age with late Ficat Stage II or Stage III disease, in which the articular involvement in the lateral roentgenogram is 50% or less.