Intertrochanteric valgus-lengthening-femoral neck osteotomy for developmental and posttraumatic conditions of the hips.

ABSTRACT

OBJECTIVE: To review the results of the treatment of coxa vara associated with femoral neck shortening and high-standing greater trochanter using the new technique of intertrochanteric valgus-lengthening-femoral neck osteotomy. MATERIAL AND METHOD: Twelve of the fifteen hips treated by the present technique of osteotomy were reviewed. Seven of the twelve cases were posttraumatic (four malunion, two nonunion and one childhood fracture of the femoral neck) and five were developmental conditions (three ischemic necrosis of the femoral head and one physeal dysplasia, all of which secondary to DDH and one coxa plana). The mean follow-up period was 34.3 months (range, 12-106). There were 5 male, 7 female. The mean age of the patients at the time of surgery was 26.6 years (range, 13-50). The operation consisted of intertrochanteric opening wedge valgus osteotomy,femoral neck lengthening by lateralization of femoral shaft and trochanteric lateralization. No bone grafting or substitute was used. RESULTS: Mean preoperative Harris hip score of 51.8 points (range, 32-67) was significantly improved to 94.8 points (range, 60-100) at the last follow-up study (p = 0.002). The mean femoral shaft-neck angle was changed from 113 degrees (range, 70-140) preoperatively to 138.2 (range, 110-165) degrees at the last follow-up (p = 0.002). Mean length gain at the last follow-up was 12.7 mm (range 5-29 mm). No complications, including delayed or non-union, implant failure and neurovascular injuries were encountered. CONCLUSION: The newly present technique could simultaneously address coxa vara associated with femoral neck shortening, and high-standing greater trochanter. The technique is safe and reliable.