Proximal Femoral Osteotomies

Abstract

A number of proximal femoral osteotomies have been described to treat patients with moderately advanced stages of osteonecrosis of the femoral head. These include varus or valgus, flexion or extension, and anterior or posterior rotation. The goal of all is to move the diseased and often collapsed segment of the femoral head out of the superior region of primary weight bearing, and to replace it with a relatively intact and viable portion of the femoral head. These procedures are technically difficult, have limited indications, require meticulous preoperative planning, and involve prolonged postoperative care. They have been done infrequently in the United States, but more commonly in other areas of the world. Reported results have varied considerably. However, in certain centers with the greatest experience, satisfactory results have been achieved in a high percentage of patients. Proximal femoral osteotomies may be indicated in selected patients with advanced stages of osteonecrosis in whom our goal is to delay or prevent the need for total hip replacement or other arthroplasties. Key Words: osteonecrosis-posterior rotational osteotomyanterior rotational osteotomy-intertrochanteric osteotomy-avascular necrosis.

Early repair of necrotic lesion of the femoral head after high-degree posterior rotational osteotomy in young patients--a study evaluated by volume measurement using magnetic resonance imaging

“…In addition, the viable region of the head constantly bears weight, resulting in the reduction of pressure on the collapsed necrotic lesion. The results of HDPRO for extensive femoral head osteonecrosis are excellent [ 14–18 ], but because it is technically demanding, in reality it is hardly widely used [ 19 ].…”

High-Degree Valgus Osteotomy for Severe Femoral Head Osteonecrosis After Femoral Neck Fracture with Nonunion

“…), who started by performing a greater trochanter osteotomy, circumferentially incising the joint capsule, and leaving the medial side intact. Then, the femoral head was subluxated 6,7 . Intertrochanteric osteotomy was performed from the distal end of the greater trochanter to the lesser trochanter using the open-wedge technique (Fig.…”