Proximal femoral osteotomy: Current indications and techniques

Abstract

Osteotomy of the proximal femur can be a useful procedure in the management of a number of different disorders around the hip. The ultimate goal of treatment is to reduce pain and prevent degeneration of the hip joint. The osteotomy can be done alone or in conjunction with other procedures in an attempt to fully address the pathology affecting the hip and lower extremity. Currently a regional variation seems to exist with regards to the indications, location, and value of these procedures, especially with the success of total hip arthroplasty (THA) in the patient with endstage arthrosis. However, with increasing numbers of replacement arthroplasty performed in young and active patients, there is a concomitant increase in the number of patients requiring challenging and complex revision procedures. Unfortunately this often leaves compromised bone stock and soft-tissue function. In our experience, obtaining a more functional native hip joint through osteotomy can delay the onset and progression of arthrosis, thereby delaying or even eliminating the need for THA. We believe that total hip arthroplasty and proximal femoral osteotomy should not be viewed as being in competition, rather each has its own distinct indications and when performed appropriately, has reproducible clinical results. Traditionally, a large proportion of femoral osteotomies were performed at the intertrochanteric region. 1-3 However, it should be noted that several other sites for performing proximal femoral osteotomy can be used to address pathology around the hip. These include an intracapsular subcapital, extracapsular base of the neck and subtrochanteric osteotomy. Osteotomy of the greater trochanter can also be used alone or in conjunction with other proximal osteotomies to help gain exposure to the hip joint and to address abductor dysfunction or trochanteric impingement. The purpose of this article is to present the indications, rationale, decision-making, and technical considerations for osteotomy of the proximal femur in the treatment of hip disorders prone to early degeneration. This article will focus primarily on the use of intertrochanteric and subcapital osteotomy.