{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:32:30Z","timestamp":1790353950330,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2017,3,22]],"date-time":"2017-03-22T00:00:00Z","timestamp":1490140800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"published-print":{"date-parts":[[2017,3,30]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Subchondral insufficiency fracture of the femoral head (SIF) occurs infrequently in young adults. As the collapsed SIF lesion is usually located at the anterior portion of the femoral head, young adults with SIF are considered to be candidates for transtrochanteric anterior rotational osteotomy, similar to patients with osteonecrosis of the femoral head (ON). In the present study, we assessed the clinical and radiographic results of anterior rotational osteotomy for the treatment of SIF as compared with ON.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 28 consecutive patients who underwent anterior rotational osteotomy for the treatment of unilateral SIF (7 patients) or unilateral ON (21 patients). The mean duration of follow-up was 3.7 years (range, 2.0 to 6.2 years). Clinical and radiographic assessments were performed with use of the Harris hip score (HHS), sequential radiographs, and single-photon emission computed tomography\/computed tomography (SPECT\/CT) with\n                      <jats:sup>99m<\/jats:sup>\n                      Tc-hydroxymethylene diphosphonate performed 5 weeks after surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The mean HHS (and standard deviation) in the SIF group improved significantly from 51.6 \u00b1 11.7 preoperatively to 91.9 \u00b1 7.1 at 1 year after surgery and to 96.9 \u00b1 3.8 at the time of the latest follow-up (p = 0.0010 and 0.0002, respectively). Similarly, the mean HHS in the ON group improved significantly from 52.4 \u00b1 13.7 preoperatively to 80.7 \u00b1 10.0 at 1 year after surgery and to 88.2 \u00b1 12.6 at the time of the latest follow-up (p &lt; 0.0001 for both). The HHS was significantly higher in the SIF group than in the ON group at 1 year after surgery (p = 0.019), but there was no significant difference between the groups at the time of the latest follow-up (p = 0.10). A postoperative intact ratio (calculated as the intact area of the femoral head divided by the weight-bearing area of the acetabulum on an anteroposterior radiograph) of &gt;80% was achieved in association with smaller femoral neck-shaft varus angles in the SIF group (10.0\u00b0 \u00b1 4.2\u00b0) as compared with the ON group (15.3\u00b0 \u00b1 8.2\u00b0). Postoperative progression of collapse at the anteriorly rotated subchondral lesion was observed in 5 patients (23.8%) in the ON group but no patients in the SIF group. SPECT\/CT images showed that rate of increased tracer uptake at the collapsed lesions in the SIF group was significantly higher than that in the ON group (p &lt; 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The present study suggested that the absence of progression of collapse and a sufficient postoperative intact ratio without the need for marked varus realignment may be associated with favorable results following anterior rotational osteotomy for the treatment of SIF in young adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.16.00013","type":"journal-article","created":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T02:24:32Z","timestamp":1490235872000},"page":"e0013","source":"Crossref","is-referenced-by-count":11,"title":["Favorable Clinical and Radiographic Results of Transtrochanteric Anterior Rotational Osteotomy for Collapsed Subchondral Insufficiency Fracture of the Femoral Head in Young Adults"],"prefix":"10.2106","volume":"2","author":[{"given":"Kazuhiko","family":"Sonoda","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goro","family":"Motomura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Ikemura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Kubo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuaki","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuharu","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,3,22]]},"reference":[{"issue":"11","key":"R1-20230811","first-page":"859","article-title":"Subchondral insufficiency fracture of the femoral head","volume":"63","author":"Bangil","year":"1996","journal-title":"Rev Rhum Engl Ed"},{"issue":"1","key":"R2-20230811","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2214\/ajr.168.1.8976940","article-title":"Insufficiency fracture of the femoral head: MR imaging in three patients","volume":"168","author":"Rafii","year":"1997","journal-title":"AJR Am J Roentgenol"},{"issue":"12","key":"R3-20230811","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1002\/1529-0131(199912)42:12<2719::AID-ANR31>3.0.CO;2-X","article-title":"Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly","volume":"42","author":"Yamamoto","year":"1999","journal-title":"Arthritis Rheum"},{"issue":"3","key":"R4-20230811","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/00000478-200003000-00017","article-title":"Insufficiency subchondral fracture of the femoral head","volume":"24","author":"Yamamoto","year":"2000","journal-title":"Am J Surg Pathol"},{"issue":"2","key":"R5-20230811","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S1297-319X(03)00050-2","article-title":"Subchondral fractures of the femoral head: a review of seven cases","volume":"71","author":"Legroux Gerot","year":"2004","journal-title":"Joint Bone Spine"},{"issue":"1","key":"R6-20230811","doi-asserted-by":"crossref","first-page":"W97","DOI":"10.2214\/AJR.12.9615","article-title":"Radiologic measurements associated with the prognosis and need for surgery in patients with subchondral insufficiency fractures of the femoral head","volume":"201","author":"Iwasaki","year":"2013","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"R7-20230811","doi-asserted-by":"crossref","first-page":"138","DOI":"10.3109\/17453679709003996","article-title":"Stress osteopathy of the femoral head. 10 military recruits followed for 5-11 years","volume":"68","author":"Visuri","year":"1997","journal-title":"Acta Orthop Scand"},{"issue":"9","key":"R8-20230811","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.2106\/00004623-200409000-00009","article-title":"Subchondral fatigue fracture of the femoral head in military recruits","volume":"86","author":"Song","year":"2004","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"R9-20230811","doi-asserted-by":"crossref","first-page":"3181","DOI":"10.1007\/s11999-010-1364-y","article-title":"Transtrochanteric rotational osteotomy for a subchondral insufficiency fracture of the femoral head in young adults","volume":"468","author":"Yamamoto","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"R10-20230811","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.clinimag.2010.05.005","article-title":"Subchondral insufficiency fracture of the femoral head in young adults","volume":"35","author":"Iwasaki","year":"2011","journal-title":"Clin Imaging"},{"issue":"11","key":"R11-20230811","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1007\/s00256-016-2462-z","article-title":"Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head","volume":"45","author":"Sonoda","year":"2016","journal-title":"Skeletal Radiol"},{"issue":"1","key":"R12-20230811","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s00256-015-2258-6","article-title":"Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging","volume":"45","author":"Iwasaki","year":"2016","journal-title":"Skeletal Radiol"},{"key":"R13-20230811","first-page":"191","article-title":"Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation","volume":"130","author":"Sugioka","year":"1978","journal-title":"Clin Orthop Relat Res."},{"key":"R14-20230811","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00003086-198209000-00015","article-title":"Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics","volume":"169","author":"Sugioka","year":"1982","journal-title":"Clin Orthop Relat Res."},{"key":"R15-20230811","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00003086-199204000-00013","article-title":"Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results","volume":"277","author":"Sugioka","year":"1992","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"R16-20230811","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1302\/0301-620X.83B1.0830083","article-title":"Trochanteric rotational osteotomy for osteonecrosis of the femoral head","volume":"83","author":"Koo","year":"2001","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"R17-20230811","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1302\/0301-620X.82B4.0820512","article-title":"Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head","volume":"82","author":"Miyanishi","year":"2000","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"R18-20230811","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s00776-012-0238-4","article-title":"Clinico-radiological factors affecting the joint space narrowing after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head","volume":"17","author":"Zhao","year":"2012","journal-title":"J Orthop Sci."},{"issue":"5","key":"R19-20230811","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s002560100348","article-title":"Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI","volume":"30","author":"Yamamoto","year":"2001","journal-title":"Skeletal Radiol"},{"issue":"5","key":"R20-20230811","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s007760200108","article-title":"The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head","volume":"7","author":"Sugano","year":"2002","journal-title":"J Orthop Sci."},{"issue":"9","key":"R21-20230811","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S0730-725X(97)00159-8","article-title":"Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients","volume":"15","author":"Kubo","year":"1997","journal-title":"Magn Reson Imaging"},{"issue":"3","key":"R22-20230811","doi-asserted-by":"crossref","first-page":"459","DOI":"10.2106\/00004623-199503000-00018","article-title":"Non-traumatic avascular necrosis of the femoral head","volume":"77","author":"Mont","year":"1995","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"R23-20230811","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/s00776-007-1123-4","article-title":"Use of a screw and plate system for a transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head","volume":"12","author":"Ikemura","year":"2007","journal-title":"J Orthop Sci."},{"issue":"5","key":"R24-20230811","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1302\/0301-620X.82B5.0820679","article-title":"Anatomy of the medial femoral circumflex artery and its surgical implications","volume":"82","author":"Gautier","year":"2000","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"R25-20230811","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","article-title":"Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation","volume":"51","author":"Harris","year":"1969","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"R26-20230811","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1302\/0301-620X.89B6.18499","article-title":"Leg-length discrepancy after transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head","volume":"89","author":"Ikemura","year":"2007","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"R27-20230811","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1053\/j.semnuclmed.2008.01.001","article-title":"Technological development and advances in single-photon emission computed tomography\/computed tomography","volume":"38","author":"Seo","year":"2008","journal-title":"Semin Nucl Med"},{"issue":"6","key":"R28-20230811","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1053\/j.semnuclmed.2009.07.005","article-title":"Multislice SPECT\/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary","volume":"39","author":"Gnanasegaran","year":"2009","journal-title":"Semin Nucl Med"},{"issue":"5","key":"R29-20230811","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1053\/j.semnuclmed.2009.06.002","article-title":"SPECT\/CT imaging in general orthopedic practice","volume":"39","author":"Scharf","year":"2009","journal-title":"Semin Nucl Med"},{"issue":"9","key":"R30-20230811","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/RLU.0000000000000886","article-title":"Bone SPECT\/CT of femoral head subchondral insufficiency fracture","volume":"40","author":"Motomura","year":"2015","journal-title":"Clin Nucl Med"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01960901-201703000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:58Z","timestamp":1787751718000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01960901-201703000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,22]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.16.00013","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,22]]}}}