Surgical Technique: Proximal Femoral Osteotomies in Residual Childhood Disease

  • Brian T. Barlow
  • Bernd Bittersohl
  • Matthew Schmitz
  • Harish S. Hosalkar
Reference work entry

Abstract

The proximal femoral osteotomy is an instrumental tool for hip deformity correction. The goal of a proximal femoral osteotomy is to return the patients’ abnormal morphology to an anatomic alignment of the proximal femur. Proximal femoral osteotomy has also been used to change the otherwise normal proximal femoral anatomy in such a way to positively benefit the hip joint through improved mechanics as well as correct global femoral malrotation.

Proximal femoral osteotomy has been used to address problems such as severe slipped capital femoral epiphysis disease, Legg-Calvé-Perthes disease, developmental dysplasia of the hip, congenital malrotation, and posttraumatic malunion of the proximal femur.

The decision to operate with a proximal femoral osteotomy is driven by patient symptoms in conjunction with altered proximal femoral anatomy and alignment. Plain radiographs and long leg alignment imaging are the key diagnostic imaging techniques when planning a proximal femoral osteotomy. The indications for surgical intervention are poorly defined by previous literature and require a complete assessment of the patient’s symptoms and diagnostic imaging.

Recently there has been renewed interest and development of new techniques of proximal femoral osteotomy to more directly address pathoanatomy. Focused research on the vascular supply to the femoral head has provided the opportunity to directly treat hip deformity that previously would have been left to natural history and inevitable coxarthrosis [1]. While these new techniques have engendered considerable interest, the long-term outcomes are not available at this point. The techniques described in the following chapter are among the most technically challenging in all of orthopedic surgery.

Keywords

Obesity Arthritis Torque Adduct Immobilization 

References

  1. 1.
    Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg. 2000;82(5):679–83.CrossRefGoogle Scholar
  2. 2.
    Peltier LF. Nicolas Andry. The designer of orthopedic iconography. Clin Orthop Relat Res. 1985;200:54–6.PubMedGoogle Scholar
  3. 3.
    Tannast M, Macintyre N, Steppacher SD, Hosalkar HS, Ganz R, Siebenrock KA. A systematic approach to analyse the sequelae of LCPD. Hip Int J Clin Exp Res Hip Pathol Ther. 2013;23 Suppl 9:61–70.Google Scholar
  4. 4.
    Paley D. The treatment of femoral head deformity and coxa magna by the Ganz femoral head reduction osteotomy. Orthop Clin North Am. 2011;42(3):389–99. viii.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Ganz R, Huff TW, Leunig M. Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect. 2009;58:241–55.PubMedGoogle Scholar
  7. 7.
    Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62–67.PubMedGoogle Scholar
  8. 8.
    Burian M, Dungl P, Nanka O, et al. Anteromedial wedge reduction osteotomy for the treatment of femoral head deformities. Hip Int J Clin Exp Res Hip Pathol Ther. 2013;23(3):281–6.Google Scholar
  9. 9.
    Alshryda S, Tsnag K, Ahmed M, Adedapo A, Montgomery R. Severe slipped upper femoral epiphysis; fish osteotomy versus pinning-in-situ: an eleven year perspective. Surg J R Coll Surg Edinb Irel. 2013. p. 1–5Google Scholar
  10. 10.
    Monazzam S, Dwek JR, Hosalkar HS. Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis. Pediatr Radiol. 2013;43(12):1599–605.PubMedCrossRefGoogle Scholar
  11. 11.
    Ramachandran M, Azegami S, Hosalkar HS. Current concepts in the treatment of adolescent femoroacetabular impingement. J Child Orthop. 2013;7(2):79–90.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Mueller ME. Intertrochanteric osteotomy: indication, preoperative planning, technique. In: Schatzker J, editor. The intertrochanteric osteotomy, vol. 1. 1st ed. New York: Springer; 1984. p. 22–66.Google Scholar
  13. 13.
    Hosalkar HS, Pandya NK, Bomar JD, Wenger DR. Hip impingement in slipped capital femoral epiphysis: a changing perspective. J Child Orthop. 2012;6(3):161–72.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Muhamad AR, Freitas JM, Bomar JD, Dwek J, Hosalkar HS. CT and MRI lower extremity torsional profile studies: measurement reproducibility. J Child Orthop. 2012;6(5):391–6.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Schai PA, Exner GU. Indication for and results of intertrochanteric osteotomy in slipped capital femoral epiphysis. Orthopade. 2002;31(9):900–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Lino Jr W, Akkari M, Waisberg G, Braga SR, Santili C. Chronic slipped capital femoral epiphysis: a radiographic evaluation of the Southwick osteotomy. J Pediatr Orthop B. 2013;22(6):536–41.PubMedCrossRefGoogle Scholar
  17. 17.
    Kartenbender K, Cordier W, Katthagen BD. Long-term follow-up study after corrective Imhauser osteotomy for severe slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20(6):749–56.PubMedCrossRefGoogle Scholar
  18. 18.
    Merchan EC, Na CM, Munuera L. Intertrochanteric osteotomy for the treatment of chronic slipped capital femoral epiphysis. Int Orthop. 1992;16(2):133–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Gordon JE, Pappademos PC, Schoenecker PL, Dobbs MB, Luhmann SJ. Diaphyseal derotational osteotomy with intramedullary fixation for correction of excessive femoral anteversion in children. J Pediatr Orthop. 2005;25(4):548–53.PubMedCrossRefGoogle Scholar
  20. 20.
    Crane L. Femoral torsion and its relation to toeing-in and toeing-out. J Bone Joint Surg Am. 1959;41-A(3):421–8.PubMedGoogle Scholar
  21. 21.
    Engel GM, Staheli LT. The natural history of torsion and other factors influencing gait in childhood. A study of the angle of gait, tibial torsion, knee angle, hip rotation, and development of the arch in normal children. Clin Orthop Relat Res. 1974;99:12–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Fabry G, Cheng LX, Molenaers G. Normal and abnormal torsional development in children. Clin Orthop Relat Res. 1994;302:22–6.PubMedGoogle Scholar
  23. 23.
    Kling Jr TF, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res. 1983;176:136–47.PubMedGoogle Scholar
  24. 24.
    McSweeny A. A study of femoral torsion in children. J Bone Joint Surg. 1971;53(1):90–5.Google Scholar
  25. 25.
    Braten M, Terjesen T, Rossvoll I. Femoral anteversion in normal adults. Ultrasound measurements in 50 men and 50 women. Acta Orthop Scand. 1992;63(1):29–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Delgado ED, Schoenecker PL, Rich MM, Capelli AM. Treatment of severe torsional malalignment syndrome. J Pediatr Orthop. 1996;16(4):484–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome. J Pediatr Orthop. 2004;24(4):392–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Keeler KA, Dart B, Luhmann SJ, et al. Antegrade intramedullary nailing of pediatric femoral fractures using an interlocking pediatric femoral nail and a lateral trochanteric entry point. J Pediatr Orthop. 2009;29(4):345–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Gordon JE, Swenning TA, Burd TA, Szymanski DA, Schoenecker PL. Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children. J Bone Joint Surg Am. 2003;85-A(7):1295–301.PubMedGoogle Scholar
  30. 30.
    Momberger N, Stevens P, Smith J, Santora S, Scott S, Anderson J. Intramedullary nailing of femoral fractures in adolescents. J Pediatr Orthop. 2000;20(4):482–4.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Brian T. Barlow
    • 1
  • Bernd Bittersohl
    • 2
  • Matthew Schmitz
    • 3
  • Harish S. Hosalkar
    • 4
  1. 1.Orthopaedic Chief ResidentNaval Medical CenterSan DiegoUSA
  2. 2.Faculty, Orthopedic Department, University Hospital DusseldorfDusseldorfGermany
  3. 3.San Antonio Military Medical CenterHoustonUSA
  4. 4.Sharp Grossmont Hospital, La Mesa, Paradise Valley Hospital, National CityVistaUSA

Personalised recommendations