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Yukihide Iwamoto - One of the best experts on this subject based on the ideXlab platform.
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transtrochanteric Rotational Osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis 10 year clinical results
Journal of Orthopaedic Science, 2016Co-Authors: Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yusuke Kohno, Yukihide IwamotoAbstract:Abstract Background Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric Rotational Osteotomy of the femoral head (TRO) for AVN. Methods This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigne–Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). Results The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Conclusions Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE.
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results of the sugioka transtrochanteric Rotational Osteotomy for osteonecrosis frequency and role of a defect of the quadratus femoris muscle in osteonecrosis progression
Orthopaedics & Traumatology-surgery & Research, 2016Co-Authors: Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Kazuyuki Karasuyama, Yukihide IwamotoAbstract:Abstract Background During transtrochanteric Rotational Osteotomy (RO), it is important to preserve the posterior column artery (PCA), which is generally located in the adipose tissue underneath the quadratus femoris muscle (QF). If there is a defect in the QF, the risk of injuring the PCA, subsequently resulting in total necrosis of the femoral head, may increase. Therefore, we investigated: (1) the frequency of defects of the QF at the time of RO, and (2) clinical outcome of RO based upon a defect of the QF. Hypothesis The presence of defects of the QF at the time of RO could be detected pre-operatively by magnetic resonance imaging. Methods RO was performed in 124 hips between 2001 and 2010. In all, 95 of the hips were in male patients and 29 in female patients. The mean age was 45.4 years (range: 11–61 years) at the time of surgery and MRI was performed before RO in all cases. We retrospectively evaluated the progression of a collapse through 3 years after RO. Results MRI showed a defect in the QF in four hips (3.2%) (2 males, 2 females), all of which were confirmed intra-operatively. Among the four patients, one (25%) underwent total hip arthroplasty because of varus deformity of the Osteotomy site due to total necrosis of the femoral head 1 year after RO. The 120 hips with a normal QF showed no evidence of total necrosis or progression of necrosis of the femoral head, indicating that the presence of defects of the QF may increase the risk of poor survivorship of this procedure. Conclusions Defects of the QF have been reported to occur in 1–2% of all patients, whereas in our study the incidence in ON was approximately 3%. In ON patients with QF defects, pre-operative MRI evaluation of the QF appears to be important when planning RO, followed by a carefully performed surgical procedure. Level of evidence IV; retrospective case series without control group.
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the choice of locking plate in the treatment of peri implant femoral fracture eight years after trans trochanteric Rotational Osteotomy a case report
International Journal of Surgery Case Reports, 2016Co-Authors: Takeshi Utsunomiya, Takuaki Yamamoto, Goro Motomura, Kazuyuki Karasuyama, Kazuhiko Sonoda, Yusuke Kubo, Hiroyuki Hatanaka, Yukihide IwamotoAbstract:Introduction Transtrochanteric anterior Rotational Osteotomy of the femoral head (TRO) was developed as a joint preserving surgery for osteonecrosis of the femoral head. To the best of our knowledge, peri-implant fractures after femoral Osteotomy have rarely been reported.
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outcome of transtrochanteric Rotational Osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow up of 12 3 years
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Kazuhiko Sonoda, Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Ryosuke Yamaguchi, Yukihide IwamotoAbstract:This study examined the outcomes of applying transtrochanteric Rotational Osteotomy (TRO) for posttraumatic osteonecrosis of the femoral head (ON). We retrospectively reviewed 28 hips in 28 patients (male, n = 17; female n = 11) with a mean age of 34.8 years (12–61 years) at the time of TRO. Transtrochanteric anterior Rotational Osteotomy (ARO) was used when the lesion was localized on the anterior aspect of the femoral head, and transtrochanteric posterior Rotational Osteotomy (PRO) was indicated in patients with lesions limited to the posterior aspect of the femoral head. The mean follow-up period was 12.3 years (5.0–21.3 years). We investigated the patients’ clinical and radiological factors, including age, sex, body mass index, preoperative Harris Hip Score (HHS), type of antecedent trauma, preoperative stage, and postoperative intact ratio (the ratio of the intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). We divided the patients into a hip-survival group and a conversion-to-total hip arthroplasty (THA) group and then compared these factors between the two groups. At the final follow-up, 22 hips had survived with a mean HHS of 85.8. The remaining six hips underwent THA at a mean of 10.2 years after TRO. The preoperative stage was correlated with hip survival. Furthermore, the postoperative intact ratio was significantly lower in the conversion-to-THA group. Based on the receiver operating characteristic curve, a ratio of less than 33.6 % was found to be associated with the need to convert to THA. TRO to correct posttraumatic ON resulted in favorable midterm results. The possible risk factors for conversion to THA were an advanced preoperative stage and a postoperative intact ratio of less than 33.6 %.
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radiological outcome analyses of transtrochanteric posterior Rotational Osteotomy for osteonecrosis of the femoral head at a mean follow up of 11 years
Journal of Orthopaedic Science, 2013Co-Authors: Garida Zhao, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Ryosuke Yamaguchi, Kenyu Iwasaki, Yukihide IwamotoAbstract:Background This study investigated the radiological factors that correlated with progression of collapse and joint space narrowing after transtrochanteric posterior Rotational Osteotomy (PRO) for osteonecrosis of the femoral head.
Takuaki Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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transtrochanteric anterior Rotational Osteotomy combined with re sphericalization of the collapsed femoral head using calcium phosphate cement filling
Surgical technology international, 2020Co-Authors: Goro Motomura, Takuaki Yamamoto, Satoshi Ikemura, Takeshi Utsunomiya, Yusuke Kubo, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:INTRODUCTION: Transtrochanteric anterior Rotational Osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. MATERIALS AND METHODS: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs. RESULTS: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric Osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. CONCLUSION: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.
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factors influencing progressive collapse of the transposed necrotic lesion after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head
Orthopaedics & Traumatology-surgery & Research, 2017Co-Authors: Yusuke Kubo, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Kazuhiko Sonoda, Yasuharu NakashimaAbstract:Background Transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) can preserve for a long-time collapsed femoral head. Progressive collapse of anteriorly-transposed necrotic lesion leads to secondary arthritic changes and clinical failure. Critical factors influencing collapse of the transposed necrotic lesion after ARO remain largely unknown. Therefore, we performed a retrospective study of ARO to determine: (1) if preoperative collapse influences collapse of the transposed necrotic area, (2) if any other factor may influence collapse of the transposed necrotic area. Hypothesis We hypothesized the degree of preoperative femoral head collapse influences progressive collapse of the transposed necrotic lesion after ARO. Materials and methods We reviewed 47 hips in 42 patients with ONFH treated with ARO between 2000 and 2005 with a mean follow-up of 11.4 years (10–14 years). The occurrence of progressive collapse of the transposed necrotic lesion after ARO was examined using lateral radiographs taken at least once every year after ARO. The following factors were statistically analyzed: age, sex, body mass index, Harris Hip Score (HHS), preoperative level of collapse, extent of the necrotic lesion and postoperative intact ratio (ratio of the transposed intact articular surface of the femoral head). Results Progressive collapse of the transposed necrotic lesion (progressive collapse group) was seen in 17 hips (36%) during a mean period of 1.8 years (0.5–3.7 years) after ARO, which has developed within 4 years in all cases. Preoperative level of collapse in the progressive collapse group (4.4 ± 1.4 mm) was significantly larger than that in the non-progressive collapse group (2.1 ± 1.0 mm), which was independently associated with progressive collapse of the transposed necrotic lesion in multivariate analysis (P < 0.0001) with cut off point of 2.98 mm. In univariate analysis, lower preoperative HHS, severe extent of the necrotic lesion and the lower postoperative intact ratio were also associated with progressive collapse of the transposed necrotic lesion, but were not associated as independent factors in multivariate analysis. Discussion The current study suggests that progressive collapse of the transposed necrotic lesion after ARO depends mainly on the preoperative level of collapse (cut-off point = 2.98 mm). Level of evidence IV; retrospective case series.
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transtrochanteric Rotational Osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis 10 year clinical results
Journal of Orthopaedic Science, 2016Co-Authors: Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yusuke Kohno, Yukihide IwamotoAbstract:Abstract Background Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric Rotational Osteotomy of the femoral head (TRO) for AVN. Methods This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigne–Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). Results The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Conclusions Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE.
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results of the sugioka transtrochanteric Rotational Osteotomy for osteonecrosis frequency and role of a defect of the quadratus femoris muscle in osteonecrosis progression
Orthopaedics & Traumatology-surgery & Research, 2016Co-Authors: Takuaki Yamamoto, Goro Motomura, Yasuharu Nakashima, Kazuyuki Karasuyama, Yukihide IwamotoAbstract:Abstract Background During transtrochanteric Rotational Osteotomy (RO), it is important to preserve the posterior column artery (PCA), which is generally located in the adipose tissue underneath the quadratus femoris muscle (QF). If there is a defect in the QF, the risk of injuring the PCA, subsequently resulting in total necrosis of the femoral head, may increase. Therefore, we investigated: (1) the frequency of defects of the QF at the time of RO, and (2) clinical outcome of RO based upon a defect of the QF. Hypothesis The presence of defects of the QF at the time of RO could be detected pre-operatively by magnetic resonance imaging. Methods RO was performed in 124 hips between 2001 and 2010. In all, 95 of the hips were in male patients and 29 in female patients. The mean age was 45.4 years (range: 11–61 years) at the time of surgery and MRI was performed before RO in all cases. We retrospectively evaluated the progression of a collapse through 3 years after RO. Results MRI showed a defect in the QF in four hips (3.2%) (2 males, 2 females), all of which were confirmed intra-operatively. Among the four patients, one (25%) underwent total hip arthroplasty because of varus deformity of the Osteotomy site due to total necrosis of the femoral head 1 year after RO. The 120 hips with a normal QF showed no evidence of total necrosis or progression of necrosis of the femoral head, indicating that the presence of defects of the QF may increase the risk of poor survivorship of this procedure. Conclusions Defects of the QF have been reported to occur in 1–2% of all patients, whereas in our study the incidence in ON was approximately 3%. In ON patients with QF defects, pre-operative MRI evaluation of the QF appears to be important when planning RO, followed by a carefully performed surgical procedure. Level of evidence IV; retrospective case series without control group.
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the choice of locking plate in the treatment of peri implant femoral fracture eight years after trans trochanteric Rotational Osteotomy a case report
International Journal of Surgery Case Reports, 2016Co-Authors: Takeshi Utsunomiya, Takuaki Yamamoto, Goro Motomura, Kazuyuki Karasuyama, Kazuhiko Sonoda, Yusuke Kubo, Hiroyuki Hatanaka, Yukihide IwamotoAbstract:Introduction Transtrochanteric anterior Rotational Osteotomy of the femoral head (TRO) was developed as a joint preserving surgery for osteonecrosis of the femoral head. To the best of our knowledge, peri-implant fractures after femoral Osteotomy have rarely been reported.
Yasuharu Nakashima - One of the best experts on this subject based on the ideXlab platform.
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transtrochanteric anterior Rotational Osteotomy combined with re sphericalization of the collapsed femoral head using calcium phosphate cement filling
Surgical technology international, 2020Co-Authors: Goro Motomura, Takuaki Yamamoto, Satoshi Ikemura, Takeshi Utsunomiya, Yusuke Kubo, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:INTRODUCTION: Transtrochanteric anterior Rotational Osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. MATERIALS AND METHODS: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs. RESULTS: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric Osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. CONCLUSION: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.
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long term hip survival and factors influencing patient reported outcomes after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head a minimum 10 year follow up case series
Modern Rheumatology, 2020Co-Authors: Koichiro Kawano, Satoshi Ikemura, Goro Motomura, Yusuke Kubo, Junichi Fukushi, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:AbstractObjectives: This retrospective study aimed to assess long-term hip survival after transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) and iden...
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the results of total hip arthroplasty after sugioka transtrochanteric anterior Rotational Osteotomy for osteonecrosis
Journal of Arthroplasty, 2017Co-Authors: Takeshi Utsunomiya, Satoshi Ikemura, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yasuharu NakashimaAbstract:Abstract Background Since Sugioka transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiological outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH. Methods Twenty-four hips in 20 patients who underwent cementless THA after ARO (Post-Osteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (Primary group). In the Post-Osteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score (HHS). A radiographic examination was performed at three months after THA and the latest follow-up. Results The HHS at the latest follow-up in the Post-Osteotomy group was equivalent to that in the Primary group, but longer operation time and greater intraoperative blood loss were observed in the Post-Osteotomy group. There were no significant differences in postoperative complications, including dislocation (two hips in each group). The leg-lengthening in the Post-Osteotomy group tended to be longer. No hips showed implant mal-positioning, loosening or required any revision surgery. Conclusions The clinicoradiological outcomes of THA after ARO are considered to be comparable to those of THA without any antecedent surgery for ONFH.
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factors influencing progressive collapse of the transposed necrotic lesion after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head
Orthopaedics & Traumatology-surgery & Research, 2017Co-Authors: Yusuke Kubo, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Kazuhiko Sonoda, Yasuharu NakashimaAbstract:Background Transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) can preserve for a long-time collapsed femoral head. Progressive collapse of anteriorly-transposed necrotic lesion leads to secondary arthritic changes and clinical failure. Critical factors influencing collapse of the transposed necrotic lesion after ARO remain largely unknown. Therefore, we performed a retrospective study of ARO to determine: (1) if preoperative collapse influences collapse of the transposed necrotic area, (2) if any other factor may influence collapse of the transposed necrotic area. Hypothesis We hypothesized the degree of preoperative femoral head collapse influences progressive collapse of the transposed necrotic lesion after ARO. Materials and methods We reviewed 47 hips in 42 patients with ONFH treated with ARO between 2000 and 2005 with a mean follow-up of 11.4 years (10–14 years). The occurrence of progressive collapse of the transposed necrotic lesion after ARO was examined using lateral radiographs taken at least once every year after ARO. The following factors were statistically analyzed: age, sex, body mass index, Harris Hip Score (HHS), preoperative level of collapse, extent of the necrotic lesion and postoperative intact ratio (ratio of the transposed intact articular surface of the femoral head). Results Progressive collapse of the transposed necrotic lesion (progressive collapse group) was seen in 17 hips (36%) during a mean period of 1.8 years (0.5–3.7 years) after ARO, which has developed within 4 years in all cases. Preoperative level of collapse in the progressive collapse group (4.4 ± 1.4 mm) was significantly larger than that in the non-progressive collapse group (2.1 ± 1.0 mm), which was independently associated with progressive collapse of the transposed necrotic lesion in multivariate analysis (P < 0.0001) with cut off point of 2.98 mm. In univariate analysis, lower preoperative HHS, severe extent of the necrotic lesion and the lower postoperative intact ratio were also associated with progressive collapse of the transposed necrotic lesion, but were not associated as independent factors in multivariate analysis. Discussion The current study suggests that progressive collapse of the transposed necrotic lesion after ARO depends mainly on the preoperative level of collapse (cut-off point = 2.98 mm). Level of evidence IV; retrospective case series.
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transtrochanteric Rotational Osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis 10 year clinical results
Journal of Orthopaedic Science, 2016Co-Authors: Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yusuke Kohno, Yukihide IwamotoAbstract:Abstract Background Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric Rotational Osteotomy of the femoral head (TRO) for AVN. Methods This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigne–Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). Results The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Conclusions Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE.
Goro Motomura - One of the best experts on this subject based on the ideXlab platform.
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transtrochanteric anterior Rotational Osteotomy combined with re sphericalization of the collapsed femoral head using calcium phosphate cement filling
Surgical technology international, 2020Co-Authors: Goro Motomura, Takuaki Yamamoto, Satoshi Ikemura, Takeshi Utsunomiya, Yusuke Kubo, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:INTRODUCTION: Transtrochanteric anterior Rotational Osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. MATERIALS AND METHODS: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs. RESULTS: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric Osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. CONCLUSION: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.
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long term hip survival and factors influencing patient reported outcomes after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head a minimum 10 year follow up case series
Modern Rheumatology, 2020Co-Authors: Koichiro Kawano, Satoshi Ikemura, Goro Motomura, Yusuke Kubo, Junichi Fukushi, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:AbstractObjectives: This retrospective study aimed to assess long-term hip survival after transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) and iden...
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the results of total hip arthroplasty after sugioka transtrochanteric anterior Rotational Osteotomy for osteonecrosis
Journal of Arthroplasty, 2017Co-Authors: Takeshi Utsunomiya, Satoshi Ikemura, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yasuharu NakashimaAbstract:Abstract Background Since Sugioka transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiological outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH. Methods Twenty-four hips in 20 patients who underwent cementless THA after ARO (Post-Osteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (Primary group). In the Post-Osteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score (HHS). A radiographic examination was performed at three months after THA and the latest follow-up. Results The HHS at the latest follow-up in the Post-Osteotomy group was equivalent to that in the Primary group, but longer operation time and greater intraoperative blood loss were observed in the Post-Osteotomy group. There were no significant differences in postoperative complications, including dislocation (two hips in each group). The leg-lengthening in the Post-Osteotomy group tended to be longer. No hips showed implant mal-positioning, loosening or required any revision surgery. Conclusions The clinicoradiological outcomes of THA after ARO are considered to be comparable to those of THA without any antecedent surgery for ONFH.
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factors influencing progressive collapse of the transposed necrotic lesion after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head
Orthopaedics & Traumatology-surgery & Research, 2017Co-Authors: Yusuke Kubo, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Kazuhiko Sonoda, Yasuharu NakashimaAbstract:Background Transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) can preserve for a long-time collapsed femoral head. Progressive collapse of anteriorly-transposed necrotic lesion leads to secondary arthritic changes and clinical failure. Critical factors influencing collapse of the transposed necrotic lesion after ARO remain largely unknown. Therefore, we performed a retrospective study of ARO to determine: (1) if preoperative collapse influences collapse of the transposed necrotic area, (2) if any other factor may influence collapse of the transposed necrotic area. Hypothesis We hypothesized the degree of preoperative femoral head collapse influences progressive collapse of the transposed necrotic lesion after ARO. Materials and methods We reviewed 47 hips in 42 patients with ONFH treated with ARO between 2000 and 2005 with a mean follow-up of 11.4 years (10–14 years). The occurrence of progressive collapse of the transposed necrotic lesion after ARO was examined using lateral radiographs taken at least once every year after ARO. The following factors were statistically analyzed: age, sex, body mass index, Harris Hip Score (HHS), preoperative level of collapse, extent of the necrotic lesion and postoperative intact ratio (ratio of the transposed intact articular surface of the femoral head). Results Progressive collapse of the transposed necrotic lesion (progressive collapse group) was seen in 17 hips (36%) during a mean period of 1.8 years (0.5–3.7 years) after ARO, which has developed within 4 years in all cases. Preoperative level of collapse in the progressive collapse group (4.4 ± 1.4 mm) was significantly larger than that in the non-progressive collapse group (2.1 ± 1.0 mm), which was independently associated with progressive collapse of the transposed necrotic lesion in multivariate analysis (P < 0.0001) with cut off point of 2.98 mm. In univariate analysis, lower preoperative HHS, severe extent of the necrotic lesion and the lower postoperative intact ratio were also associated with progressive collapse of the transposed necrotic lesion, but were not associated as independent factors in multivariate analysis. Discussion The current study suggests that progressive collapse of the transposed necrotic lesion after ARO depends mainly on the preoperative level of collapse (cut-off point = 2.98 mm). Level of evidence IV; retrospective case series.
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transtrochanteric Rotational Osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis 10 year clinical results
Journal of Orthopaedic Science, 2016Co-Authors: Yasuharu Nakashima, Takuaki Yamamoto, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yusuke Kohno, Yukihide IwamotoAbstract:Abstract Background Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric Rotational Osteotomy of the femoral head (TRO) for AVN. Methods This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigne–Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). Results The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Conclusions Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE.
Satoshi Ikemura - One of the best experts on this subject based on the ideXlab platform.
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transtrochanteric anterior Rotational Osteotomy combined with re sphericalization of the collapsed femoral head using calcium phosphate cement filling
Surgical technology international, 2020Co-Authors: Goro Motomura, Takuaki Yamamoto, Satoshi Ikemura, Takeshi Utsunomiya, Yusuke Kubo, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:INTRODUCTION: Transtrochanteric anterior Rotational Osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. MATERIALS AND METHODS: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs. RESULTS: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric Osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. CONCLUSION: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.
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long term hip survival and factors influencing patient reported outcomes after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head a minimum 10 year follow up case series
Modern Rheumatology, 2020Co-Authors: Koichiro Kawano, Satoshi Ikemura, Goro Motomura, Yusuke Kubo, Junichi Fukushi, Satoshi Hamai, Masanori Fujii, Yasuharu NakashimaAbstract:AbstractObjectives: This retrospective study aimed to assess long-term hip survival after transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) and iden...
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the results of total hip arthroplasty after sugioka transtrochanteric anterior Rotational Osteotomy for osteonecrosis
Journal of Arthroplasty, 2017Co-Authors: Takeshi Utsunomiya, Satoshi Ikemura, Goro Motomura, Junichi Fukushi, Satoshi Hamai, Yasuharu NakashimaAbstract:Abstract Background Since Sugioka transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiological outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH. Methods Twenty-four hips in 20 patients who underwent cementless THA after ARO (Post-Osteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (Primary group). In the Post-Osteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score (HHS). A radiographic examination was performed at three months after THA and the latest follow-up. Results The HHS at the latest follow-up in the Post-Osteotomy group was equivalent to that in the Primary group, but longer operation time and greater intraoperative blood loss were observed in the Post-Osteotomy group. There were no significant differences in postoperative complications, including dislocation (two hips in each group). The leg-lengthening in the Post-Osteotomy group tended to be longer. No hips showed implant mal-positioning, loosening or required any revision surgery. Conclusions The clinicoradiological outcomes of THA after ARO are considered to be comparable to those of THA without any antecedent surgery for ONFH.
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factors influencing progressive collapse of the transposed necrotic lesion after transtrochanteric anterior Rotational Osteotomy for osteonecrosis of the femoral head
Orthopaedics & Traumatology-surgery & Research, 2017Co-Authors: Yusuke Kubo, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Kazuhiko Sonoda, Yasuharu NakashimaAbstract:Background Transtrochanteric anterior Rotational Osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) can preserve for a long-time collapsed femoral head. Progressive collapse of anteriorly-transposed necrotic lesion leads to secondary arthritic changes and clinical failure. Critical factors influencing collapse of the transposed necrotic lesion after ARO remain largely unknown. Therefore, we performed a retrospective study of ARO to determine: (1) if preoperative collapse influences collapse of the transposed necrotic area, (2) if any other factor may influence collapse of the transposed necrotic area. Hypothesis We hypothesized the degree of preoperative femoral head collapse influences progressive collapse of the transposed necrotic lesion after ARO. Materials and methods We reviewed 47 hips in 42 patients with ONFH treated with ARO between 2000 and 2005 with a mean follow-up of 11.4 years (10–14 years). The occurrence of progressive collapse of the transposed necrotic lesion after ARO was examined using lateral radiographs taken at least once every year after ARO. The following factors were statistically analyzed: age, sex, body mass index, Harris Hip Score (HHS), preoperative level of collapse, extent of the necrotic lesion and postoperative intact ratio (ratio of the transposed intact articular surface of the femoral head). Results Progressive collapse of the transposed necrotic lesion (progressive collapse group) was seen in 17 hips (36%) during a mean period of 1.8 years (0.5–3.7 years) after ARO, which has developed within 4 years in all cases. Preoperative level of collapse in the progressive collapse group (4.4 ± 1.4 mm) was significantly larger than that in the non-progressive collapse group (2.1 ± 1.0 mm), which was independently associated with progressive collapse of the transposed necrotic lesion in multivariate analysis (P < 0.0001) with cut off point of 2.98 mm. In univariate analysis, lower preoperative HHS, severe extent of the necrotic lesion and the lower postoperative intact ratio were also associated with progressive collapse of the transposed necrotic lesion, but were not associated as independent factors in multivariate analysis. Discussion The current study suggests that progressive collapse of the transposed necrotic lesion after ARO depends mainly on the preoperative level of collapse (cut-off point = 2.98 mm). Level of evidence IV; retrospective case series.
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radiological outcome analyses of transtrochanteric posterior Rotational Osteotomy for osteonecrosis of the femoral head at a mean follow up of 11 years
Journal of Orthopaedic Science, 2013Co-Authors: Garida Zhao, Takuaki Yamamoto, Satoshi Ikemura, Goro Motomura, Ryosuke Yamaguchi, Kenyu Iwasaki, Yukihide IwamotoAbstract:Background This study investigated the radiological factors that correlated with progression of collapse and joint space narrowing after transtrochanteric posterior Rotational Osteotomy (PRO) for osteonecrosis of the femoral head.
