By L. Ramirez. Paine College. 2017.

Our findings indicate that if necrotic lesions are limited medially and the lateral part of the femoral head remains intact buy discount naltrexone 50mg line, good long-term results can be obtained by simple varus osteotomy, which supports the results of Kerboul et al. Excessive varus correction is related to a high incidence of postoperative limp because of abductor muscle weakness and limb shortening. Our results indicated that excessive varus correction should be avoided and that the correction angle should be planned up to 25°. In hips with correction angles within 25°, postoperative limp was sometimes found several months after the osteotomy, but this usually improved within 1 or 2 years. Sugioka reported a technique of transtrochanteric anterior rotational osteotomy for osteonecrosis in 1978. Successful results by this technique were described by several other Japanese surgeons [10,18,23]. In the United States, however, successful results were not obtained with this technique [11,12,13]. Sugioka’s osteotomy has sometimes been described as a technically demanding procedure [11–13,19]. In the surgical technique of intertrochanteric osteotomy, it is often difficult to obtain precise correction angles as preoperatively planned. Varus-valgus angulation correction is relatively easy by measuring the angle of the guided Kirschner wires in relation to the femur shaft. Flexion-extension correction is sometimes difficult because the intra- operative lateral views of intertrochanteric regions are sometimes slightly oblique when the patient is in the operative lateral decubitus position, and corrective guides such as Kirschner wires on the true lateral view sometimes do not depict true flexion- extension correction angles. We therefore prefer simple varus osteotomy in which flexion-extension correction does not have to be considered.

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