Trochanteric rotational osteotomy in patients with concomitant osteonecrosis of the femoral head and trochanter: A case report

Purpose: Trochanteric rotational osteotomy is a treatment option for osteonecrosis of the femoral head (ONFH). However, if ONFH is concomitant with osteonecrosis of the femoral trochanter (ONT), there is a concern that post-osteotomy bone union at the trochanter may be affected. Methods and results: We report the case of a 28-year-old woman who underwent anterior rotational osteotomy (ARO) for ONFH that developed after steroid treatment for acute lymphoblastic leukemia. MRI showed ONT in addition to ONFH. The area of ONT coincided with the planned osteotomy line. We performed bone scintigraphy and single-photon emission computed tomography (SPECT) in addition to MRI to evaluate the biological activity of the ONT area. There were areas of uptake on SPECT and bone scintigraphy at the ONT, suggesting the potential for biological viability; thus, we performed ARO. Bone union was observed six months postoperatively, and the Harris hip score was 100 points two years postoperatively. Conclusion: Biological activity assessment using SPECT and bone scintigraphy may be useful for assessing bone union capacity at the time of osteotomy.