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特発性大腿骨頭壊死症に対して大腿骨頭前方回転骨切り術(ARO)を行い,その後に人工股関節置換術(THA)に至った10症例についてTHA施行時の問題点を検討した.全例とも骨切りの併用や特殊なステムを使用することなく,通常のセメントレスステムを使用することができた.しかし,ARO後のTHAに際しては,大腿骨近位の変形や骨硬化のため髄腔リーマーの挿入やラスプが困難となるため,初回のTHAよりもステムが内反設置になりやすい点に注意が必要であると思われた.
We investigated the clinical and radiographic outcome of 10 patients who underwent total hip arthroplasty (THA) after previous anterior rotational osteotomy (ARO) for idiopathic osteonecrosis of the femoral head. THA was performed using conventional femoral components without additional osteotomy in all patients. The average of JOA score was 53 preoperatively and 91 at the final follow-up examination, an average of 2 years 5 months after the THA. No major complications occurred. However, since in 2 patients the stem/femoral shaft angle was 5 degrees varus as a result of dense reactive sclerotic bone on the lateral side of the canal, careful canal preparation is required for THA to avoid femoral component malposition in patients who have undergone ARO.
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