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MRI‐based surgical simulation of transtrochanteric rotational osteotomy for femoral head osteonecrosis
Author(s) -
Koyama Tsuyoshi,
Sugano Nobuhiko,
Nishii Takashi,
Miki Hidenobu,
Takao Masaki,
Sato Yoshinobu,
Yoshikawa Hideki,
Tamura Shinichi
Publication year - 2009
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.20568
Subject(s) - femoral head , medicine , osteotomy , rotation (mathematics) , weight bearing , surgical planning , nuclear medicine , surgery , radiology , orthodontics , geometry , mathematics
Transtrochanteric rotational osteotomy (TRO) is one of the joint‐preserving surgical treatments for osteonecrosis of the femoral head (ONFH). It can prevent collapse of the femoral head as necrotic lesions in the weight‐bearing portion can be moved sufficiently to a less weight‐bearing portion by anterior rotation, posterior rotation, or varus angulation. Patient selection and preoperative planning are important to determine indications for TRO. It has been reported that successful TRO requires at least 34% of the weight‐bearing area supported by the intact part of the femoral head. However, this ratio is difficult to preoperatively quantify according to the rotation angle using conventional two‐dimensional MR images or X‐rays. Therefore, we developed a method of simulating TRO using three‐dimensional (3D) models reconstructed from 3D MR images and applied it to serial patients with types C1 and C2 osteonecrosis at stage 1 or 2. The simulation visualized positional changes of the necrotic lesion in the weight‐bearing area and enabled quantitation of the postoperative intact ratio. Our surgical simulation is useful for evaluating the postoperative intact ratio and for determining indications for TRO as well as the optimal angle of femoral head rotation and varus angulation. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 447–451, 2009