Skip to main content

Valgus intertrochanteric osteotomy for coxa vara of Bucholz–Ogden Types II and III in patients older than 30 years

Archives of Orthopaedic and Trauma Surgery volume 131, pages 1211–1217 (2011)Cite this article

Abstract

Background

Ischemic necrosis of the proximal femur resulting in coxa vara is a severe iatrogenous complication of the treatment of developmental dysplasia of the hip (DDH). Severe relative overgrowth of the greater trochanter and reduction of the neck result in insufficiency of hip abductors. Unequal limb length causes obliquity of the pelvis, compensatory scoliosis of the lumbar spine and valgus deformity of the ipsilateral knee. The purpose of this study was to investigate the effect of valgus intertrochanteric osteotomy in patients with coxa vara older than 30 years.

Methods

Fifteen female patients of the average age 43 years (range 31–60) with postdysplastic varus deformity of the proximal femur and shortening of affected limb of 2–4 cm were treated with valgus intertrochanteric osteotomy. None of them was operated on before. In eight cases, the varus deformity of the proximal femur was evaluated as Bucholz-Ogden Type II, in seven cases as Bucholz–Ogden Type III. The average follow-up was 10 years (range 5–20).

Results

By the time of the last functional follow-up, three patients had already underwent conversion of osteotomy to total hip arthroplasty (THA), namely, 7.5, 11, and 12 years after osteotomy. All the patients evaluated the effect of osteotomy positively, including those treated later with THA. The average preoperative Harris Hip Score was 83, the postoperative one was 93.

Conclusions

Based on results, the valgus intertrochanteric osteotomy appears to be a reliable treatment for postdysplastic coxa vara in patients older than 30 years.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Bucholz RW, Ogden JA (1978) Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital dislocation of the hip. In: The Hip. Proceedings of the sixth open scientific meeting of the hip society. St. Louis, Mosby, pp 43–63

  2. Thomas CL, Gage JR, Ogden JA (1982) Treatment concepts for proximal femoral ischemic necrosis complicating congenital hip disease. J Bone Joint Surg Am 74:817–828

    Google Scholar 

  3. Vávra J, Čech O, Zídka M (2000) Valgus osteotomy in the treatment of the ischemic necrosis of femoral head in children. Part II—Clinical evaluation of the group. Acta Chir Orthop Traumatol Čech 67:77–87

    PubMed  Google Scholar 

  4. Wagner H (1977) Korrekturosteotomien am Bein. Orthopäde 6:145–177

    Google Scholar 

  5. Morscher E (1980) Intertrochanteric osteotomy in the treatment of osteoarthritis of the hip. In: The Hip. Proceedings of the eight open scientific meeting of the hip society. St. Louis, Mosby pp 24–46

  6. Papavasiliou V, Kirkos JM (1997) Reconstruction of residual deformities of the hip. Clin Orthop Relat Res 341:123–127

    PubMed  Article  Google Scholar 

  7. Lengsfled M, Schuler P, Griss P (2001) The long term (8–12 years) results of valgus and lengthening osteotomy of the femoral neck. Arch Orthop Trauma Surg 121:201–204

    Article  Google Scholar 

  8. Graf R, Tschauner C, Klapsch W (1992) Dreifachosteotomie des proximalen Femurendes bei Coxa vara mit Hochstand des Trochanter major und Beinverkürzung. Operativ Orthop Traumatol 4:50–62

    Article  Google Scholar 

  9. Sharp IK (1961) Acetabular dysplasia: acetabular angle. J Bone Joint Surg Br 43-B:268–272

    Google Scholar 

  10. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand 83(Suppl 57):1–138

    Google Scholar 

  11. Bosworth DM, Fielding JW, Ishizuka T, Ege R (1961) Hip-shelf operation in adults. J Bone Joint Surg Am 43-A:93–106

    Google Scholar 

  12. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51-A:737–755

    Google Scholar 

  13. Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer, New York

    Google Scholar 

  14. Bartoníček J, Skála-Rosenbaum J, Douša P (2003) Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures. J Orthop Trauma 17:606–612

    PubMed  Article  Google Scholar 

  15. Bartoníček J, Havránek P (2004) Gunshot injury of the proximal femoral physis. Arch Orthop Trauma Surg 124:69–71

    PubMed  Article  Google Scholar 

  16. Bartoníček J, Vávra J, Bartoška R (2010) Operative treatment of avascular necrosis of the femoral head after slipped capital femoral epiphysis. Arch Orthop Trauma Surg. doi:10.1007/s00402-010-1161-9

  17. Perlau R, Wilson MG, Poss R (1996) Isolated proximal femoral osteotomy for treatment of residua of congenital dysplasia or idiopathic osteotoarthrosis of the hip. J Bone Joint Surg Am 78-A:1462–1467

    Google Scholar 

  18. Haverkamp D, Marti RK (2005) Intertrochanteric osteotomy combined with acetabular shelfplasty in young patients with severe deformity of the femoral head and secondary osteoarthritis. J Bone Joint Surg Br 87:25–31

    PubMed  CAS  Google Scholar 

  19. Buess P, Morscher E (1988) Die schenkalsverlängernde Osteotomie mit Distalisierung des Trochanter major bei Coxa vara nach Hüftluxation. Orthopäde 17:485–490

    PubMed  CAS  Google Scholar 

  20. Müller ME (1971) Die hüftnähen Femurosteotomien. 2. Auflage, Stuttgart

    Google Scholar 

  21. Pauwels F (1976) Biomechanics of the normal and diseased hip. Berlin, Springer

    Google Scholar 

  22. Schatzker J (ed) (1984) The intertrochanteric osteotomy. Berlin, Springer

    Google Scholar 

  23. Santore RF, Kantor SR (2004) Intertrochanteric femoral osteotomies for developmental and posttraumatic conditions. J Bone Joint Surg Am 86:2542–2553

    Google Scholar 

  24. Haverkamp D, Eijer H, Besselaar PP, Marti RK (2008) Awareness and use of intertrochanteric osteotomies in current clinical practice. An international survey. Int Orthop 32:19–25

    PubMed  Article  CAS  Google Scholar 

  25. Zweifel J, Hönle W, Schuh A (2010) Long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip. Int Orthop. doi:10.1007/s00264-009-0870-6

Download references

Acknowledgments

This study was supported by a grant from the Ministry of Health of the Czech RepublicGrant IGA MZ: NS 9980-3 Importance of intertrochanteric osteotomy and acetabular coverage procedures at adolescent and adults for preservation of long-term hip function.

Author information

Affiliations

  1. Department of Surgery of the 1st Faculty of Medicine, Charles University, Thomayer University Hospital, Vídeňská 800, 142 00, Prague-4, Czech Republic

    Jan Bartoníček

  2. Orthopaedic Department of 3rd Faculty of Medicine, Charles University, 100 34, Prague 10, Czech Republic

    Jaroslav Vávra

Authors
  1. Jan Bartoníček
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaroslav Vávra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Bartoníček.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bartoníček, J., Vávra, J. Valgus intertrochanteric osteotomy for coxa vara of Bucholz–Ogden Types II and III in patients older than 30 years. Arch Orthop Trauma Surg 131, 1211–1217 (2011). https://doi.org/10.1007/s00402-011-1278-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-011-1278-5

Keywords

  • Coxa vara
  • Intertrochanteric osteotomy
  • DDH