Subclinical infection associated with delayed union after transtrochanteric rotational osteotomy

Abstract

Goro Motomura1, Takuaki Yamamoto1, Sanshiro Inoue2, Yasuharu Nakashima1, Taro Mawatari1, Yukihide Iwamoto11Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; 2Department of Orthopaedic Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, JapanAbstract: Infected nonunion of the transtrochanteric osteotomy site is an uncommon complication of transtrochanteric anterior rotational osteotomy. A 45-year-old male underwent anterior rotational osteotomy for osteonecrosis of the left femoral head. A radiograph obtained 4 months after surgery showed the presence of osteolytic lesions around the trochanteric wire, and the transtrochanteric osteotomy site appeared to be fuzzy. In spite of the continuation of partial weight bearing, osteolytic changes progressed. An open biopsy was performed 13 months after surgery. Samples were taken from multiple sites, including osteolytic lesions, one of which was confirmed to contain coagulase-negative staphylococcus. Nineteen days after performing thorough debridement and irrigation, the patient underwent a refixation of the osteotomy site using an iliac bone graft and a sliding hip screw system. A radiograph obtained at the final follow-up revealed bone union at the site of osteotomy.Keywords: osteonecrosis, infected nonunion, osteotomy