Modified femoral neck rotational osteotomy with supercapsular approach as hip preservation surgery technique for osteonecrosis of femoral head in young patient: A case report

Treatment of osteonecrosis of the femoral head in Ficat stage III after femoral neck fracture in children and adolescents by basicervical femoral neck rotational osteotomy

Aims

Osteonecrosis of the femoral head (ONFH) after femoral neck fracture poses challenges in children, particularly at Ficat stage III. Limited effective treatments are available. This study explores basicervical femoral neck rotational osteotomy (BFNRO) for ONFH following fracture of the femoral neck in children and adolescents, and evaluates its outcomes.

Methods

Children and adolescents with ONFH (Fiat stage III) following fracture who underwent BFNRO at our centre from June 2017 to September 2022 were included. Follow-up exceeded one year, with data on modified Harris Hip Score (mHHS), range of motion (ROM), patient satisfaction, femoral head collapse, necrotic area repair, leg length, and osteoarthritis (OA) progression recorded.

Results

This study included 15 patients (15 hips; eight male and seven female) with a mean age of 12.9 years (10 to 17). Nine patients had BFNRO alone, and six had combined periacetabular osteotomy. Rotation angles varied from 70° to 90° for anterior rotation and 110° to 135° for posterior rotation. Nine patients had femoral neck fixation in a varus position (10° to 30°). The postoperative contour of the weightbearing area of the femoral head has significantly improved in all patients. At a mean follow-up of 28.6 months (12.2 to 72.7), mean mHHS significantly improved (65.2 (SD 8.6) to 90.2 (SD 5.8); p < 0.001). Only one patient showed femoral head further collapse. Patients experienced no/mild hip pain (visual analogue scale 0 to 3), slight restriction in ROM, and mild limb shortening. Two patients had OA progression. No infections or nerve injuries were observed, and no arthoplasies undertaken.

Conclusion

Even with late stage ONFH after fracture, BFNRO in children and adolescents can provide positive early to mid-term results by relocating the necrotic area and restoring the integrity of the anterior-lateral column of the femoral head, thereby preventing femoral head collapse and delaying the onset of severe OA.

Network meta-analysis of invasive treatment for early-stage osteonecrosis of the femoral head

BACKGROUND

Osteonecrosis of the femoral head (ONFH) is a common disabling disease in orthopedics. Blocking the progression of ONFH in the early stage is essential for avoiding total hip replacement.

PURPOSES

The purpose of this study is to evaluate the effect of invasive treatment on early-stage ONFH.

METHODS

According to the PRISMA guidelines, relevant English databases were searched in August 2022 to collect published research. Extract result indicators and conduct network meta-analysis using R software.

RESULTS

A total of 15 RCTs were included. All patients were diagnosed with early-stage ONFH. The surface under the cumulative ranking curve (SUCRA) showed that CD + BMMSC and CD + PRP were the most effective in improving HHS. The results of the league table showed that CD + BMMSC was superior to CD alone. Meanwhile, the SUCRA for FR showed that CD + BG + BMMSC was the most likely to be the most effective in reducing FR. The league table revealed that CD + BG, CD + BG + BMMSC, and CD + BMMSC were superior to CD alone, with statistically significant differences.

CONCLUSION

Considering the HHS and FR, CD + BMMSC may be the optimal treatment option to effectively delay the progression of ONFH and restore the postoperative function of patients.

REGISTRATION NUMBER

The study protocol has been registered on the PROSPERO platform (CRD42023380169).