Abstract
Purpose
Relative femoral neck lengthening (RNL) is a newer technique to correct coxa breva and coxa vara to relieve a femoro-acetabular impingement and improve hip abductor function without changing the position of the head on the shaft. Proximal femoral osteotomy (PFO) changes the position of the femoral head relative to the shaft. We studied the short-term complications of procedures that combined RNL with PFO.
Methods
All hips that underwent RNL and PFO using a surgical dislocation and extended retinacular flap development were included. Hips that were treated only with intra-articular femoral osteotomies (IAFO) were excluded. Hips that underwent RNL and PFO, with IAFO and/or acetabular procedures were included. Intra-operative evaluation of the femoral head blood flow was performed with the drill hole technique. Clinical evaluation and hip radiographs were obtained at 1 week, 6 weeks, 3 months, 6 months, 12 months and 24 months.
Results
Seventy two patients (31 males, 41 females, 6–52 years of age) underwent 79 combined RNL and PFO. 22 hips underwent additional procedures like head reduction osteotomy, femoral neck osteotomy, and acetabular osteotomies. There were 6 major and 5 minor complications noted. Two hips developed non-unions, both with basicervical varus-producing osteotomies. Four hips developed femoral head ischemia. Two of these hips avoided collapse with early intervention. One hip had persistent abductor weakness requiring hardware removal and three hips, all in boys developed symptomatic widening of the hip on the operated side from varus-producing osteotomy. One hip had asymptomatic trochanteric non-union.
Conclusion
RNL is routinely performed by releasing the short external rotator muscle tendon insertion from the proximal femur to raise the posterior retinacular flap. Though this technique protects the blood supply from direct injury, it seems to stretch the vessels with major corrections in the proximal femur. We recommend evaluating the blood flow intraoperatively and postoperatively and taking necessary steps early to decrease the stretch on the flap. It may be safer to avoid raising the flap for major extra-articular proximal femur corrections.
Significance
The results of this study suggest ways to improve the safety of procedures that combine RNL and PFO.
Similar content being viewed by others
Data availability
Authors declare that required data will be provided if required.
References
Albers, C. E., Steppacher, S. D., Schwab, J. M., Tannast, M., & Siebenrock, K. A. (2015). Relative femoral neck lengthening improves pain and hip function in proximal femoral deformities with a high-riding trochanter. Clinical Orthopaedics, 473(4), 1378–1387.
Anderson, L. A., Erickson, J. A., Severson, E. P., & Peters, C. L. (2010). Sequelae of Perthes disease: treatment with surgical hip dislocation and relative femoral neck lengthening. Journal Pediatr Orthop, 30(8), 758–766.
Ganz, R., Gill, T. J., Gautier, E., Ganz, K., Krügel, N., & Berlemann, U. (2001). Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. Journal Bone Joint Surg Br, 83-B(8), 1119–1124.
Ganz, R., Huff, T. W., & Leunig, M. (2009). Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instructional Course Lectures, 58, 241–255.
Leibold, C. S., Vuillemin, N., Büchler, L., Siebenrock, K. A., & Steppacher, S. D. (2022). Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg–Calve–Perthes disease. Operative Orthopädie und Traumatologie, 34(5), 352–360.
Rebello, G., Spencer, S., Millis, M. B., & Kim, Y. J. (2009). Surgical dislocation in the management of pediatric and adolescent hip deformity. Clinical Orthopaedics, 467(3), 724–731.
Erickson, J. B., Samora, W. P., & Klingele, K. E. (2017). Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy. Journal of Children’s Orthopaedics, 11(4), 284–288.
Baraka, M. M., Hefny, H. M., Thakeb, M. F., Fayyad, T. A., Abdelazim, H., Hefny, M. H., et al. (2020). Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. Journal of Children’s Orthopaedics, 14(3), 190–200.
Gill, T. J., Sledge, J. B., Ekkernkamp, A., & Ganz, R. (1998). Intraoperative assessment of femoral head vascularity after femoral neck fracture. Journal Orthopaedics Trauma, 12(7), 474–478.
Hasler, C. C., & Morscher, E. W. (1999). Femoral neck lengthening osteotomy after growth disturbance of the proximal femur. Journal Pediatric Orthopaedics Part B, 8(4), 271–275.
Lascombes, P., Prevot, J., Allouche, A., Ligier, J. N., & Metaizeau, J. P. (1985). Lengthening osteotomy of the femoral neck with transposition of the greater trochanter in acquired coxa vara. Revue de Chirurgie Orthopedique et Reparatrice de l’Appareil Moteur, 71(8), 599–601.
Gautier, E., Ganz, K., Krügel, N., Gill, T., & Ganz, R. (2000). Anatomy of the medial femoral circumflex artery and its surgical implications. Journal Bone Joint Surg Br, 82-B(5), 679–683.
Schai, P. A., & Exner, G. U. (2007). Die intertrochantäre Korrekturosteotomie nach Imhäuser. Operative Orthopädie und Traumatologie, 19(4), 368–388.
Kartenbender, K., Cordier, W., & Katthagen, B. D. (2000). Long-term follow-up study after corrective imhäuser osteotomy for severe slipped capital femoral epiphysis. Journal of Pediatric Orthopaedics, 20, 749–756.
Parilla, F. W., Nepple, J. J., Pashos, G. E., Schoenecker, P. L., & Clohisy, J. C. (2022). Is combined surgical dislocation and proximal femoral osteotomy a safe procedure for correction of complex hip deformities? Journal of Hip Preservation Surgery, 9(2), 126–133.
Funding
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
None declared.
Informed Consent
Written consent for publication of patient details was obtained from the patient/parent/guardian.
Ethical approval
Ethical approval was waived by the local Ethics Committee of University A in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gourineni, P.V., Valleri, D.p., Chauhan, P. et al. Short-Term Complications of Relative Femoral Neck Lengthening Combined with Extra-Articular Osteotomies of the Proximal Femur. JOIO 57, 1112–1117 (2023). https://doi.org/10.1007/s43465-023-00895-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-023-00895-6