Femoral neck osteotomy in skeletally mature patients: surgical technique and midterm results

Abstract

Purpose Using an extended retinacular flap containing the blood supply for the femoral head, proximal femur osteotomies can be performed at the neck level increasing the potential of correction of complex morphologies. The aim of this study was to analyze the safety, clinical, and radiographic results of this intra-articular surgical technique performed in skeletally mature patients with a minimum follow-up of three years. Methods Fourteen symptomatic adult patients (16 hips) with a mean age of 26 years underwent FNO using surgical hip dislocation and an extended soft tissue flap. Radiographs and radial magnetic resonance imaging (MRI) were obtained before and after surgery to evaluate articular congruency, cartilage damage, and morphologic parameters. Clinical functional evaluation was done using the Nonarthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). Results After surgery, no avascular necrosis was observed, and all the osteotomies healed without complication. The initial neck/ shaft angle (range 120 to 150°) improved in all cases to a mean value of 130°± 4.6 (p < 0.001). In eight of nine valgus hips, the high-positioned fovea capitis changed to a normal position after surgery. The NAHS score improved from a mean of 36.5 ± 14.9 to 82.9 ± 13.9 points after surgery (p < 0.001). After surgery, the mean HOS was 87.1 ± 17.6 points, and the mean mHHS was 78.6 ± 17 points. Conclusions In this series, femoral neck osteotomy in the adult, although technically more demanding compared with other classic osteotomies, can be considered a safe procedure with considerable potential to correct hip deformities.

A new special femoral neck osteotomy method for application in the surgical treatment of patients with ankylosing spondylitis and severe thoracolumbar kyphosis combined with hip flexion contracture

“…FNO is usually used to correct hip deformities [7]. Zeng reported performing femoral osteotomy for stage I and THA two weeks later for stage II to treat patients with ankylosing spondylitis with severe hip contracture.…”

Long-term results of valgus intertrochanteric osteotomy for partial avascular necrosis of the femoral head after femoral neck fracture in adolescents

“…In 2021, ve of these patients with their informed consent (two male and three female), with a minimal follow-up period of 15 years, were examined (Table 1). The mean age of these patients at the time of injury was 13.6 years (range, [12][13][14][15][16][17][18][19] and at the time of VITO 16.7 years (range, 14-21); the mean injury-VITO interval was 36 months (range, . The average follow-up was 17 years (range; [15][16][17][18][19][20].…”

“…The mean age of these patients at the time of injury was 13.6 years (range, [12][13][14][15][16][17][18][19] and at the time of VITO 16.7 years (range, 14-21); the mean injury-VITO interval was 36 months (range, . The average follow-up was 17 years (range; [15][16][17][18][19][20]. The primary injury was caused in one case by a car accident, in two cases by a fall whilst skiing, in one case by a fall from a tree, and in one case by slipping on a wet oor.…”

“…Final assessment: All patients were followed up over the whole period by the senior author (JB). The mean follow-up period was 17 years (range, [15][16][17][18][19][20]. Subjective assessment was based on the patients' satisfaction with the surgery.…”

“…The published studies describe multiple methods of its treatment, ranging from core decompression up to total hip replacement [7,[10][11][12][13][14]. One of these methods is intertrochanteric osteotomy (ITO) based on the principle of reorientation of the necrotic segment of the femoral head away from the weight-bearing zone of the hip joint [15][16][17]. Although this method is mentioned quite frequently, there are only a few studies in the literature dealing with it in detail, mostly in the form of case reports, with the follow-up period not exceeding seven years [14,15,[18][19][20].…”