Can rotating damaged hip bone help children retain hip function after osteonecrosis following a fracture?

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Osteonecrosis of the femoral head after femoral neck fracture (ONFHpoFNFx) is challenging to treat in children, particularly at Ficat stage III, and few effective treatments are available. This study evaluated basicervical femoral neck rotational osteotomy (BFNRO) and its outcomes in children and adolescents with this condition.

This single-center surgical outcomes study included children and adolescents with Ficat stage III ONFHpoFNFx who underwent BFNRO at the center between June 2017 and September 2022. Follow-up exceeded 1 year. The researchers recorded the modified Harris hip score (mHHS), range of motion (ROM), patient satisfaction, femoral head collapse, repair of the necrotic area, leg length, and osteoarthritis progression.

There were 15 cases involving 15 hips: 8 males and 7 females, with a mean age of 12.9 years (range: 10–17 years). Nine cases underwent BFNRO alone, and six underwent BFNRO combined with PAO. Rotation angles ranged from 70° to 90° for anterior rotation and from 110° to 135° for posterior rotation. In nine patients, the femoral neck was fixed in a varus position of 10° to 30°.

After surgery, the contour of the weight-bearing area of the femoral head improved significantly in all patients. At a mean follow-up of 28.6 months (range: 12.2–72.7 months), mHHS improved significantly from 65.2 to 90.2 (P<0.001). Only one patient showed femoral head collapse. Patients had no or mild hip pain (VAS=0–3), slight restriction of range of motion, and mild limb shortening. Two patients showed osteoarthritis progression. No infections, joint replacements, or nerve injuries were observed.

The authors concluded that BFNRO can yield positive early- to mid-term results in children and adolescents even with late-stage ONFHpoFNFx. They attributed this potential benefit to relocating the necrotic area and restoring the integrity of the anterior-lateral column of the femoral head, with the aim of preventing femoral head collapse and delaying severe osteoarthritis.