Can rotation osteotomy remain effective for more than ten years?

Trochanteric rotation osteotomies displace the necrotic zone of the femoral head outside the major acetabular weight-bearing zone and rotate the head anteriorly or posteriorly. Nineteen consecutive patients were selected for rotation osteotomy based on age,absence of progressive disease, and preoperative imaging studies predicting that rotation osteotomy would move the entire necrotic zone away from the acetabular roof. Factors associated with failure were head flattening and necrosis deeper than one third of the femoral head diameter. Among patient subsets with identical disease stages, outcomes seemed better after posterior rotation than after anterior rotation. Rotation osteotomies,fixed by a nail plate, can be recommended in a few selected patients with shallow necrosis involving less than one third of the femoral head diameter and without osteoarthritis or head flattening. Under these conditions, good outcomes may be achieved for 10 years or longer.