Summary
Objectives
Intertrochanteric adduction osteotomy to delay or prevent the development of a coxofemoral osteoarthritis. No removal of bony wedge thus avoiding leg shortening.
Indications
Coxa valga with or without hip dysplasia; epiphyseal dysplasia; valgus head; circumscribed avascular necrosis; osteochondritis dissecans.
Contraindications
Osteoarthritis of hip with marginal osteophytes; severe osteoporosis; spasticity.
Surgical Technique
Lateral approach. The position of the blade in the proximal fragment determines the amount of correction. Intertrochanteric adduction osteotomy perpendicular to the femoral shaft. Lining up and approximation of the distal femur to the plate of the bladeplate. If the correction of adduction exceeds 25°, the trochanter is transferred distally.
Results
A follow-up after an average of 32 months of 42 patients treated by us for an avascular necrosis of the femoral head with an intertrochanteric adduction osteotomy and a vascularized iliac bone graft showed excellent and good results in 83%. Mont et al. reported excellent and good results of an intertrochanteric adduction osteotomy for avascular necrosis in 76% after an average follow-up of 11 years.
Other studies showed that an intertrochanteric adduction osteotomy with or without an acetabuloplasty performed for congenital dysplasia of the hip gave excellent and good results between 63 and 87% after an average of 21 and 26 years.
The outcome of intertrochanteric adduction osteotomy done for concentric osteoarthritis was reported in 2 other studies; intertrochanteric adduction osteotomy resulted in excellent and good results in 53 to 63% after 11 to 15 years.
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Siebenrock, KA., Ekkernkamp, A. & Ganz, R. The corrective intertrochanteric adduction osteotomy without removal of a wedge. Orthop Traumatol 8, 1–13 (2000). https://doi.org/10.1007/BF03181115
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DOI: https://doi.org/10.1007/BF03181115