Surgical technique: Proximal femoral osteotomies in residual childhood disease

Abstract

The proximal femoral osteotomy is an instrumental tool for hip deformity correction. The goal of a proximal femoral osteotomy is to return the patients’ abnormal morphology to an anatomic alignment of the proximal femur. Proximal femoral osteotomy has also been used to change the otherwise normal proximal femoral anatomy in such a way to positively benefit the hip joint through improved mechanics as well as correct global femoralmalrotation. Proximal femoral osteotomy has been used to address problems such as severe slipped capital femoral epiphysis disease, Legg-Calvé-Perthes disease, developmental dysplasia of the hip, congenital malrotation, and posttraumatic malunion of the proximal femur. The decision to operate with a proximal femoral osteotomy is driven by patient symptoms in conjunction with altered proximal femoral anatomy and alignment. Plain radiographs and long leg alignment imaging are the key diagnostic imaging techniques when planning a proximal femoral osteotomy. The indications for surgical intervention are poorly defined by previous literature and require a complete assessment of the patient's symptoms and diagnostic imaging. Recently there has been renewed interest and development of new techniques of proximal femoral osteotomy to more directly address pathoanatomy. Focused research on the vascular supply to the femoral head has provided the opportunity to directly treat hip deformity that previously would have been left to natural history and inevitable coxarthrosis [1]. While these new techniques have engendered considerable interest, the long-term outcomes are not available at this point. The techniques described in the following chapter are among the most technically challenging in all of orthopedic surgery.