Anatomic and clinical study of virtual reality technology assisted modified transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIA Tianwei ¹ , JI Wenhui ² , LIU Jinzhu ¹ , QIU Yue ¹ , HUAN Dawei ¹ ,  SHEN Jirong ¹

1. Department of Orthopedics, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China;
2. Department of Orthopedics, Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine·Hebei, Cangzhou Hebei, 061000, P.R.China;

Corresponding author：

SHEN Jirong, Email: joint66118@sina.com

Keywords：

Hip-preserving surgery; transtrochanteric varus osteotomy; osteonecrosis of the femoral head; virtual reality technology

DOI：

10.7507/1002-1892.202108006

Video：

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Objective To explore the feasibility and effectiveness of the modified transtrochanteric curved varus osteotomy in the treatment of osteonecrosis of the femoral head (ONFH), clarify the key points of the operation, and then explore the effectiveness of modified transtrochanteric curved varus osteotomy in the treatment of ONFH assisted by virtual reality (VR) technology. Methods A 70-year-old adult female cadaver without formaldehyde fixation was taken. It was confirmed by anatomical study and simulated operation that the modified transtrochanteric curved varus osteotomy was suitable for type C1 (patients with involvement of the lateral column of the femoral head but partial integrity) classified by the Japanese Osteonecrosis Investigation Committee (JIC). Between October 2018 and August 2020, 11 patients (17 hips) with ONFH who met the selection criteria were treated with modified transtrochanteric curved varus osteotomy. VR technology was used to simulate varus osteotomy before operation to predict the angle of valgus of lower limbs and pronation of femoral head. Osteotomy, valgus, and pronation were performed according to the results of preoperative planning. After operation, X-ray films were used to evaluate the changes of varus and neck-shaft angle after VR assisted surgery, and Harris score was used to evaluate the hip function. Results The anteroposterior pelvic X-ray film was rechecked at 2 days after operation, of which 3 hips were consistent with the planned varus angle of VR preoperative planning, and the error value of varus angle of the remaining 14 hips was 1°-4°. The difference between VR preoperative planning and 2 days after operation was 6°-16°. All 11 patients were followed up 11-28 months, with an average of 19.2 months. All incisions healed by first intension. During the follow-up, 1 case (1 hip) developed greater trochanter fracture at 2 months after operation and was treated with open reduction and plate and screw internal fixation; 1 case (1 hip) had delayed healing at osteotomy at 4 months after operation and healed at 3 months after local injection of platelet rich plasma and oral supplementation of kidney blood-strengthening soup. At last follow-up, 17 hip osteotomies healed. The Harris score was 84.0±5.6, which was significantly higher than that before operation (57.2±5.5) (t=–14.107, P=0.000); hip function was excellent in 2 hips, good in 13 hips, and fair in 2 hips. Conclusion The modified transtrochanteric curved varus osteotomy for the treatment of ONFH is theoretically feasible, and the short-term effectiveness of this operation combined with VR technology is satisfactory.

Citation： XIA Tianwei, JI Wenhui, LIU Jinzhu, QIU Yue, HUAN Dawei, SHEN Jirong. Anatomic and clinical study of virtual reality technology assisted modified transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1580-1586. doi: 10.7507/1002-1892.202108006 Copy

1.	Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: Results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
2.	Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
3.	Pauwels F. The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle, 1968, 8(6): 196-210.
4.	Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
5.	Yusuke O, Taisuke S, Toshiaki O, et al. Long-term outcomes of curved intertrochanteric varus osteotomy combined with bone impaction grafting for non-traumatic osteonecrosis of the femoral head. Bone Joint J, 2021, 103-B(4): 665-671.
6.	Shohat N, Copeliovitch L, Smorgick Y, et al. The long-term outcome after varus derotational osteotomy for Legg-Calvé-Perthes disease: A mean follow-up of 42 years. J Bone Joint Surg (Am), 2016, 98(15): 1277-1285.
7.	Ito H, Kaneda K, Matsuno T. Osteonecrosis of the femoral head. Simple varus intertrochanteric osteotomy. J Bone Joint Surg (Br), 1999, 81(6): 969-974.
8.	Mont MA, Fairbank AC, Krackow KA, et al. Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg (Am), 1996, 78(7): 1032-1038.
9.	Pavlovcic V, Dolinar D. Intertrochanteric osteotomy for osteonecrosis of the femoral head. Int Orthop, 2002, 26(4): 238-242.
10.	郑潮顺, 李春海. 虚拟现实技术在骨科术前规划中的应用. 中国骨科临床与基础研究杂志, 2017, 9(5): 310-315.
11.	Bekelis K, Calnan D, Simmons N, et al. Effect of an immersivepreoperative virtual reality experience on patient reportedoutcomes: A randomized controlled trial. Ann Surg, 2017, 265(6): 1068-1073.
12.	Inao S, Ando M, Gotoh E, et al. Minimum 10-year results of Sugioka’s osteotomy for femoral head osteonecrosis. Clin Orthop Relat Res, 1999, (368): 141-148.
13.	Takashima K, Sakai T, Hamada H, et al. Which classification system is most useful for classifying osteonecrosis of the femoral head? Clin Orthop Relat Res, 2018, 476(6): 1240-1249.
14.	李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型——中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
15.	Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res, 1978, (130): 191-201.
16.	周思佳, 姜文学. 基于CJFH分型的股骨头坏死三维分型及塌陷预测. 中国组织工程研究, 2018, 22(19): 3033-3038.
17.	Kalhor M, Beck M, Huff TW, et al. Capsular and pericapsular contributions to acetabular and femoral head perfusion. J Bone Joint Surg (Am), 2009, 91(2): 409-418.
18.	肖凯, 罗殿中, 程徽, 张振东, 张洪. 股骨颈基底部旋转截骨术治疗早期股骨头坏死的临床疗效. 中华骨科杂志, 2018, 38(7): 425-432.
19.	Okura T, Hasegawa Y, Morita D, et al. What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head? Arch Orthop Trauma Surg, 2016, 136(12): 1647-1655.
20.	高润子, 夏天卫, 环大维, 等. 虚拟现实技术辅助下经股骨颈基底部旋转截骨术治疗股骨头坏死11例. 中国中医骨伤科杂志, 2021, 29(5): 51-55.

1. Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: Results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
2. Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
3. Pauwels F. The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle, 1968, 8(6): 196-210.
4. Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
5. Yusuke O, Taisuke S, Toshiaki O, et al. Long-term outcomes of curved intertrochanteric varus osteotomy combined with bone impaction grafting for non-traumatic osteonecrosis of the femoral head. Bone Joint J, 2021, 103-B(4): 665-671.
6. Shohat N, Copeliovitch L, Smorgick Y, et al. The long-term outcome after varus derotational osteotomy for Legg-Calvé-Perthes disease: A mean follow-up of 42 years. J Bone Joint Surg (Am), 2016, 98(15): 1277-1285.
7. Ito H, Kaneda K, Matsuno T. Osteonecrosis of the femoral head. Simple varus intertrochanteric osteotomy. J Bone Joint Surg (Br), 1999, 81(6): 969-974.
8. Mont MA, Fairbank AC, Krackow KA, et al. Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg (Am), 1996, 78(7): 1032-1038.
9. Pavlovcic V, Dolinar D. Intertrochanteric osteotomy for osteonecrosis of the femoral head. Int Orthop, 2002, 26(4): 238-242.
10. 郑潮顺, 李春海. 虚拟现实技术在骨科术前规划中的应用. 中国骨科临床与基础研究杂志, 2017, 9(5): 310-315.
11. Bekelis K, Calnan D, Simmons N, et al. Effect of an immersivepreoperative virtual reality experience on patient reportedoutcomes: A randomized controlled trial. Ann Surg, 2017, 265(6): 1068-1073.
12. Inao S, Ando M, Gotoh E, et al. Minimum 10-year results of Sugioka’s osteotomy for femoral head osteonecrosis. Clin Orthop Relat Res, 1999, (368): 141-148.
13. Takashima K, Sakai T, Hamada H, et al. Which classification system is most useful for classifying osteonecrosis of the femoral head? Clin Orthop Relat Res, 2018, 476(6): 1240-1249.
14. 李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型——中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
15. Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res, 1978, (130): 191-201.
16. 周思佳, 姜文学. 基于CJFH分型的股骨头坏死三维分型及塌陷预测. 中国组织工程研究, 2018, 22(19): 3033-3038.
17. Kalhor M, Beck M, Huff TW, et al. Capsular and pericapsular contributions to acetabular and femoral head perfusion. J Bone Joint Surg (Am), 2009, 91(2): 409-418.
18. 肖凯, 罗殿中, 程徽, 张振东, 张洪. 股骨颈基底部旋转截骨术治疗早期股骨头坏死的临床疗效. 中华骨科杂志, 2018, 38(7): 425-432.
19. Okura T, Hasegawa Y, Morita D, et al. What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head? Arch Orthop Trauma Surg, 2016, 136(12): 1647-1655.
20. 高润子, 夏天卫, 环大维, 等. 虚拟现实技术辅助下经股骨颈基底部旋转截骨术治疗股骨头坏死11例. 中国中医骨伤科杂志, 2021, 29(5): 51-55.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomic and clinical study of virtual reality technology assisted modified transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head

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