Femoral Neck Lengthening Osteotomy After Growth Disturbance of the Proximal Femur

Abstract

Treatment of congenital dislocation of the hip, Perthes disease, bacterial coxitis, or fractures in childhood may be complicated by vascular insufficiency and subsequent growth disturbance of the proximal femur. The resulting deformity, with a high-standing greater trochanter and a short femoral neck, causes leg length shortening and insufficiency of the hip abductors with a positive Trendelenburg sign and limp. Normal anatomy and biomechanics of the hip joint can be restored by lengthening the femoral neck after two parallel osteotomies of the femur at the the upper and lower border of the femoral neck, followed by distalization the greater trochanter. This femoral neck lengthening osteotomy was first described by the senior author (EM) in 1980. This retrospective study of 37 operated patients with a mean follow-up of 8 years shows good results in 32 patients with little or no preexisting osteoarthritis. Four of five patients with marked degenerative changes underwent a total hip replacement within 1 to 9 years after the osteotomy.