Efficacy of teriparatide and factors for the collapse of femoral head following femoral curved varus osteotomy

Osteonecrosis of the femoral head (ONFH) often leads to femoral head collapse, which makes joint preservation challenging. Although curved varus osteotomy (CVO) is an effective surgical method for joint preservation in young ONFH patients, there are some cases where it cannot prevent femoral head collapse. This research aims to evaluate the usefulness of teriparatide (TPD) in bone healing and preventing femoral head collapse in CVO-treated ONFH patients. This retrospective study included 48 patients (56 hips) diagnosed with ONFH, categorized into three groups: glucocorticoid-associated ONFH with TPD treatment (GCs + TPD), glucocorticoid-associated ONFH (GCs), and alcohol- associated ONFH (Alc). No significant differences were found in terms of surgical details, stage, conversion to total hip arthroplasty (THA), and clinical scores. The GCs + TPD group showed a shorter bone union duration, reduced femoral head collapse, and a lower incidence of advanced collapse than the other groups. Lower BMI and TPD use were associated with a shorter duration of bone union. TPD and union duration were identified as factors contributing to the advanced collapse. In conclusion, TPD administration accelerates bone union at the osteotomy site and mitigates femoral head collapse after joint-preserving osteotomy. In addition, combining TPD with CVO may be a promising strategy for younger patients.