Pedicle bone grafting versus transtrochanteric rotational osteotomy for idiopathic osteonecrosis of the femoral head--four patients with both procedures.

The clinical and radiographic results of vascularized pedicle iliac bone grafting (PBG) and Sugioka's transtrochanteric anterior rotational osteotomy of the femoral head (ARO) for idiopathic osteonecrosis of the femoral head were compared. Four male patients with bilateral osteonecrosis of the femoral head were treated with PBG in the first hip and with ARO in the second. All patients had stage 2 or 3 involvement according to Ficat's classification. Average age at the time of PBG and ARO was 42 and 43 years, respectively. Average follow-up of PBG and ARO was 7.5 and 5.7 years. At final follow-up, the average Harris hip scores of PBG and ARO were 73 and 85, respectively. Collapse was observed in 3 PBG hips and in 1 ARO hip. Three patients were more satisfied with the ARO procedure than with the PBG treatment, and one patient was undecided. ARO was considered better surgical treatment than PBG from both a clinical and radiological perspective.