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Purpose <p>Curved intertrochanteric varus osteotomy (CVO) is a joint-preserving procedure for osteonecrosis of the femoral head (ONFH); however, postoperative femoral head collapse remains a concern. Although the intact ratio has traditionally been assessed using plain radiography, the clinical relevance of computed tomography (CT)-based intact ratios remains unclear. This study aimed to evaluate the usefulness of the postoperative CT-based intact ratio in predicting the progression of collapse after CVO.</p> Methods <p>We retrospectively reviewed data from 54 patients (58 hips) with non-traumatic ONFH who underwent CVO. Collapse progression was defined as an increase in collapse depth ≥ 3&#xa0;mm compared with the immediate postoperative state. The patients were categorized into collapse and non-collapse groups. The intact ratio was measured on central coronal CT images of the femoral head. Receiver operating characteristic (ROC) curve analysis and Kaplan–Meier survival analysis were performed.</p> Results <p>With a mean follow-up of 47.4&#xa0;months, collapse progression occurred in 12 hips (21.1%). The postoperative CT-based intact ratio was significantly higher in the non-collapse than in the collapse group (48.4 ± 14.3% vs. 31.8 ± 13.4%, <i>P</i> = 0.001). ROC analysis showed an optimal cutoff value of 39.2% (area under the curve = 0.809). Kaplan–Meier analysis revealed significantly lower three&#xa0;year survivorship with postoperative CT-based intact ratios &lt; 39.2% versus ≥ 39.2% (50.6% vs. 92.1%, <i>P</i> &lt; <i>0.001).</i></p> Conclusions <p>The postoperative CT-based intact ratio was a strong predictor of femoral head collapse progression, with an optimal cutoff value of 39.2%. Applying conventional radiograph-based thresholds directly to CT evaluations may lead to an underestimation of the risk of collapse.</p>

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Postoperative computed tomography-based intact ratio predicts femoral head collapse after curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Hiroaki Ido,
  • Yusuke Osawa,
  • Yasuhiko Takegami,
  • Hiroto Funahashi,
  • Keiji Otaka,
  • Shiro Imagama

摘要

Purpose

Curved intertrochanteric varus osteotomy (CVO) is a joint-preserving procedure for osteonecrosis of the femoral head (ONFH); however, postoperative femoral head collapse remains a concern. Although the intact ratio has traditionally been assessed using plain radiography, the clinical relevance of computed tomography (CT)-based intact ratios remains unclear. This study aimed to evaluate the usefulness of the postoperative CT-based intact ratio in predicting the progression of collapse after CVO.

Methods

We retrospectively reviewed data from 54 patients (58 hips) with non-traumatic ONFH who underwent CVO. Collapse progression was defined as an increase in collapse depth ≥ 3 mm compared with the immediate postoperative state. The patients were categorized into collapse and non-collapse groups. The intact ratio was measured on central coronal CT images of the femoral head. Receiver operating characteristic (ROC) curve analysis and Kaplan–Meier survival analysis were performed.

Results

With a mean follow-up of 47.4 months, collapse progression occurred in 12 hips (21.1%). The postoperative CT-based intact ratio was significantly higher in the non-collapse than in the collapse group (48.4 ± 14.3% vs. 31.8 ± 13.4%, P = 0.001). ROC analysis showed an optimal cutoff value of 39.2% (area under the curve = 0.809). Kaplan–Meier analysis revealed significantly lower three year survivorship with postoperative CT-based intact ratios < 39.2% versus ≥ 39.2% (50.6% vs. 92.1%, P < 0.001).

Conclusions

The postoperative CT-based intact ratio was a strong predictor of femoral head collapse progression, with an optimal cutoff value of 39.2%. Applying conventional radiograph-based thresholds directly to CT evaluations may lead to an underestimation of the risk of collapse.