MASAFUMI HOMMA, M.D.,D.M.Sc, Research Fellow of Orthopaedic Surgery

RICHARD BOWEN, M.D., Pediatric Orthopaedic Surgeon, Chairman

October. 26,1995







K.B.. 12-year-old boy. B.W. 63 kg(139 Ib.) . Perthes disease. He had right hip pain and limping for seven weeks. When he was first seen at University Hospital of Niigata, the right femoral head was deformed already and collapsed slightly on X-ray. The lateral part of the femoral head showed an impingement lesion. Because good sphericity of the posterior part of the femoral head was still preserved, Sugioka's rotational osteotomy was advised. Pre-operative range of motion was flex.90, abd.35, e.r. 40, and i.r. 15. The femoral head was anteriorly rotated by 75 degrees and varus angulation by 15 degrees was made. Continuous-passive-motion and pulley exercise on a bed was started from the 1st post-operative day. Skin traction was performed for 2 weeks. After post-operative non-weight-bearing for 4 weeks, and partial-weight-bearing for 6 weeks, he has had neither limping nor pain for more than 3 years.


W.H.. 12-year-old-girl. Post-traumatic avascular necrosis of rt. femoral head. She sustained the right femoral neck fracture by falling from a balcony. After bed-rest for 2 weeks, she started walking with crutches. She completely returned to normal activities 6 months after the trauma. She was beginning to complain of the right hip pain 2 years after the trauma. A large area of avascular necrosis was in weight bearing surface of the femoral head. The large posterior surface of the femoral head remained intact. A Sugioka osteotomy was performed with 90 degrees of anterior rotation and 15 degrees of varus angulation. After post-operative non-weight-bearing for 4 weeks, and partial-weight-bearing for 6 weeks, she has had neither limping nor pain so far.



  1. Skin incision: a modified Ollier's incision, or a lateral oblique incision.
  2. Osteotomized the greater trochanter and reflect it proximally with the gluteus medius muscle.
  3. Transect the short external rotator muscles and quadratus femoris muscle. Care must be taken to avoid injury to the posterior branch of the medial circumflex artery, which lies just above the lesser trochanter and can easily be seen at the time of transection of the short rotators and the quadratus femoris muscle.
  4. A circumferential incision is made in the hip joint capsule near the acetabular rim.
  5. The first osteotomy is made, 10mm distal to the intertrochanteric crest, toward the lesser trochanter, and in a plane perpendicular to the neck in every direction.
  6. To determine the osteotomy plane, two K-wires are placed through the denuded surface of the greater trochanter both anterioly and posterioly in a plane perpendicular to the another K-wire which is placed along the femoral neck.
  7. A second osteotomy is performed from the upper margin of the lesser trochanter to the first osteotomy line.
  8. When an anterior rotation of 70 degrees or more is required, the iliopsoas tendon should be transected near the lesser trochanter before rotation.
  9. Two large pins are inserted parallel into proximal and distal fragments, and femoral head is rotated anteriorly by handling proximal pin.
  10. After adequate rotation, a large screw is inserted in valgus position. An A-P X-ray should be taken to ensure the weight-bearing portion is well apposed and the neck-shaft angle. Then a Steinman pin is removed and another large pin is inserted. The A-O compression screw is ineffective because of its thin shank.
  11. The intentional varus position may be made in addition to anterior rotation for an extensive lesion.






  1. Sugioka Y.: Transtrchanteric rotational osteotomy of the femoral head. In Riley, L.H.Jr.(ed.): The Hip. Proceedings of the Eighth Open Scinentific Meetingof the Hip Society. St. Louis, C.V. Mosby, 1980.pp.3-23.
  2. Sugioka Y.: Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: A new osteotomy operation. Clin. Orthop. 130: 191-201,1978.
  3. Sugioka Y., Katsuki I., and Hotokebuchi T.: Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis: Follow-up statistics. Clin. Orthop. 169: 115-126,1982.
  4. Sugioka Y.: Transtrochanteric rotational osteotomy in the treatment of idiopathic and steroid-induced femoral head necrosis, Perthes' disease, slipped capital femoral epiphysis, and osteoarthritis of the hip: indications and results, Clin. Orthop. 184: 12-23,1983.