Skip to main content
SpringerLink
Log in

Proximal Femoral Osteotomy

  • Chapter
  • First Online:
Hip Dysplasia

Abstract

The proximal femoral osteotomy is a valuable adjunct to the treatment of native hip instability and dysplasia. The indications for an osteotomy are diverse and may include correction of upper femoral deformity, improvement of articular congruity often in conjunction with acetabular procedures, reduction of risk of avascular necrosis in high-grade dysplasia, correction of gait abnormalities, and management of early-onset arthritis in young patients. Appropriate preoperative planning requires consideration of multiple factors including proximal femoral deformity in the sagittal, coronal, and frontal planes as well as the overall mechanical axis of the limb. Proper planning will optimize patient outcomes and minimize complications, including alteration in limb alignment, generation of limb length discrepancy, and creation of deformities that will potentially compromise subsequent surgical intervention, especially total hip arthroplasty. Finally, the choice of fixation, including blade plate, proximal femoral locking plate, and intramedullary nails, should be guided by surgical experience and comfort as well as the ability to restore biomechanics using any selected device.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, et al. Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res. 2003;417:27–40.

    Google Scholar 

  2. Robertson DD, Essinger JR, Imura S, Kuroki Y, Sakamaki T, Shimizu T, et al. Femoral deformity in adults with developmental hip dysplasia. Clin Orthop Relat Res. 1996;327:196–206.

    Article  Google Scholar 

  3. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br. 1998;80(4):711–9.

    Article  CAS  Google Scholar 

  4. Clohisy JC, Nunley RM, Carlisle JC, Schoenecker PL. Incidence and characteristics of femoral deformities in the dysplastic hip. Clin Orthop Relat Res. 2009;467(1):128–34.

    Article  Google Scholar 

  5. Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res. 2008;466(4):782–90.

    Article  CAS  Google Scholar 

  6. McKibbin B. Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg Br. 1970;52(1):148–59.

    Article  CAS  Google Scholar 

  7. Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81(12):1747–70.

    Article  CAS  Google Scholar 

  8. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clin Orthop Relat Res. 2013;471(12):3774–80.

    Article  Google Scholar 

  9. Bombelli R, Gerundini M, Aronson J. The biomechanical basis for osteotomy in the treatment of osteoarthritis of the hip: results in younger patients. Hip. 1984:18–42.

    Google Scholar 

  10. Sanchez-Sotelo J, Trousdale RT, Berry DJ, Cabanela ME. Surgical treatment of developmental dysplasia of the hip in adults: I. nonarthroplasty options. J Am Acad Orthop Surg. 2002;10(5):321–33.

    Article  Google Scholar 

  11. Hersche O, Casillas M, Ganz R. Indications for intertrochanteric osteotomy after periacetabular osteotomy for adult hip dysplasia. Clin Orthop Relat Res. 1998;347:19–26.

    Article  Google Scholar 

  12. Wyles CC, Heidenreich MJ, Jeng J, Larson DR, Trousdale RT, Sierra RJ. The John Charnley award: redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clin Orthop Relat Res. 2017;475(2):336–50.

    Article  Google Scholar 

  13. Ganz R, Horowitz K, Leunig M. Algorithm for femoral and periacetabular osteotomies in complex hip deformities. Clin Orthop Relat Res. 2010;468(12):3168–80.

    Article  Google Scholar 

  14. Groves EWH. The treatment of congenital dislocation of the hip joint with special reference to open operative reduction. London: Oxford University Press; 1928.

    Google Scholar 

  15. Ombredanne L. Precis Clinique et Operatoire de Chirurgie Infantile. Paris: Masson; 1923.

    Google Scholar 

  16. Schoenecker PL, Strecker WB. Congenital dislocation of the hip in children. Comparison of the effects of femoral shortening and of skeletal traction in treatment. J Bone Joint Surg Am. 1984;66(1):21–7.

    Article  CAS  Google Scholar 

  17. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years. J Pediatr Orthop. 1995;15(6):768–79.

    Article  CAS  Google Scholar 

  18. Sankar WN, Tang EY, Moseley CF. Predictors of the need for femoral shortening osteotomy during open treatment of developmental dislocation of the hip. J Pediatr Orthop. 2009;29(8):868–71.

    Article  Google Scholar 

  19. Turgeon TR, Phillips W, Kantor SR, Santore RF. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Clin Orthop Relat Res. 2005;441:188–99.

    Article  Google Scholar 

  20. Pauwels P. Biomechanics of the normal and diseased hip: theoretical foundation, technique and results of treatment: an atlas. Berlin: Springer-Verlag; 1976.

    Google Scholar 

  21. Jingushi S, Sugioka Y, Noguchi Y, Miura H, Iwamoto Y. Transtrochanteric valgus osteotomy for the treatment of osteoarthritis of the hip secondary to acetabular dysplasia. J Bone Joint Surg Br. 2002;84(4):535–9.

    Article  CAS  Google Scholar 

  22. Iwase T, Hasegawa Y, Kawamoto K, Iwasada S, Yamada K, Iwata H. Twenty years’ followup of intertrochanteric osteotomy for treatment of the dysplastic hip. Clin Orthop Relat Res. 1996;331:245–55.

    Article  Google Scholar 

  23. Iwase T, Hasegawa Y, Iwasada S, Kitamura S, Iwata H. Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis. Clin Orthop Relat Res. 1999;364:175–81.

    Article  Google Scholar 

  24. Gotoh E, Inao S, Okamoto T, Ando M. Valgus-extension osteotomy for advanced osteoarthritis in dysplastic hips. Results at 12 to 18 years. J Bone Joint Surg Br. 1997;79(4):609–15.

    Article  CAS  Google Scholar 

  25. Maistrelli GL, Gerundini M, Fusco U, Bombelli R, Bombelli M, Avai A. Valgus-extension osteotomy for osteoarthritis of the hip. Indications and long-term results. J Bone Joint Surg Br. 1990;72(4):653–7.

    Article  CAS  Google Scholar 

  26. Langlais F, Roure JL, Maquet P. Valgus osteotomy in severe osteoarthritis of the hip. J Bone Joint Surg Br. 1979;61-B(4):424–31.

    Article  CAS  Google Scholar 

  27. Perlau R, Wilson MG, Poss R. Isolated proximal femoral osteotomy for treatment of residua of congenital dysplasia or idiopathic osteoarthrosis of the hip. Five to ten-year results. J Bone Joint Surg Am. 1996;78(10):1462–7.

    Article  CAS  Google Scholar 

  28. Okano K, Enomoto H, Osaki M, Shindo H. Outcome of rotational acetabular osteotomy for early hip osteoarthritis secondary to dysplasia related to femoral head shape: 49 hips followed for 10–17 years. Acta Orthop. 2008;79(1):12–7.

    Article  Google Scholar 

  29. Pauwels F. Biomechanics of the locomotor axis. Berlin/Heidelberg: Springer-Verlag; 1980.

    Book  Google Scholar 

  30. Luo CF. Reference axes for reconstruction of the knee. Knee. 2004;11(4):251–7.

    Article  Google Scholar 

  31. Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res. 1990;255:215–27.

    Google Scholar 

  32. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res. 1992;280:48–64.

    Google Scholar 

  33. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994;25(3):425–65.

    CAS  PubMed  Google Scholar 

  34. Greis PE, Ward WT, Rodosky M, Rudert MJ, Stanitski C. A clinical and comparative biomechanical evaluation of proximal femoral osteotomy fixation in children. Orthopedics. 1993;16(3):273–9.

    CAS  PubMed  Google Scholar 

  35. Rutz E, Brunner R. The pediatric LCP hip plate for fixation of proximal femoral osteotomy in cerebral palsy and severe osteoporosis. J Pediatr Orthop. 2010;30(7):726–31.

    Article  Google Scholar 

  36. Rocak K, Poul J, Urbasek K. Accuracy of proximal femur correction achieved with LCP paediatric hip plates. Acta Chir Orthop Traumatol Cechoslov. 2013;80(4):273–7.

    CAS  Google Scholar 

  37. Chung MK, Kwon SS, Cho BC, Lee GW, Kim J, Moon SJ, et al. Incidence and risk factors of hardware-related complications after proximal femoral osteotomy in children and adolescents. J Pediatr Orthop B. 2018;27(3):264–70.

    PubMed  Google Scholar 

  38. Jain A, Thompson JM, Brooks JT, Ain MC, Sponseller PD. Implant-related fractures in children with proximal femoral osteotomy: blade plate versus screw-side plate constructs. J Pediatr Orthop. 2016;36(1):e1–5.

    Article  Google Scholar 

  39. Khouri N, Khalife R, Desailly E, Thevenin-Lemoine C, Damsin JP. Proximal femoral osteotomy in neurologic pediatric hips using the locking compression plate. J Pediatr Orthop. 2010;30(8):825–31.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beaumont Health, Department of Orthopedic Surgery, Royal Oak, MI, USA

    Erika Daley

  2. Oakland University William Beaumont School of Medicine, Department of Orthopedic Surgery, Royal Oak, MI, USA

    Ira Zaltz

Authors
  1. Erika Daley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ira Zaltz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erika Daley .

Editor information

Editors and Affiliations

  1. University of Ottawa Orthopedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Paul E. Beaulé

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Daley, E., Zaltz, I. (2020). Proximal Femoral Osteotomy. In: Beaulé, P. (eds) Hip Dysplasia. Springer, Cham. https://doi.org/10.1007/978-3-030-33358-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-33358-4_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-33357-7

  • Online ISBN: 978-3-030-33358-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation