Femoral Hip Osteotomy
A femoral osteotomy (cutting and repositioning the upper thigh bone) is recommended for the treatment of disorders resulting from improper formation of the femur. These disorders include CAM type femoral acetabular impingement and developmental hip dysplasia where there is a large angle between the femoral neck and femoral shaft (coxa valga). Femoral osteotomy can also be performed to treat residual deformities from slipped capital femoral epiphysis that may show up in young adulthood after the child has stopped growing.
A femoral osteotomy involves cutting and repositioning of the proximal femur (part of the femur closer to the pelvis) in order to distribute force more evenly over the hip joint surfaces. The goal of this surgery is to prevent uneven wear on the joint over time, and thus prevent the development of osteoarthritis. A femoral osteotomy is performed by cutting and realigning the bones at the inter-trochanteric level, or between the lesser and greater trochanters. The bone cut is then stabilized using plates and screws. Performing the surgery at the inter-trochanteric level is best for avoiding major blood vessels. This helps reduce the likelihood of potential complications such as avascular necrosis.
In the first part of the procedure, the proximal femur is cut into pieces. The pieces are repositioned to achieve the optimal angle between the femoral neck and femoral shaft. A metal plate is then added in order to hold the cut pieces together in the correct position. guide wires are used to determine the best position for this metal plate. After the metal plate is correctly positioned, it is fixed to the femoral shaft with screws.
Recovery from femoral osteotomy includes the use of a brace or Spica cast post-operatively to supplement the hardware that was used to fix the bone in place. Weight-bearing on the hip is initially minimal, but can be gradually increased as the bone heals until full weight-bearing is achieved. Overall, complete recovery from a femoral osteotomy takes between 3 and 12 months depending on the patients age and the actual osteotomy that is performed. This is because it takes time for the bone to fuse together in its new position. In order to regain strength and range of motion after the surgery, physical therapy and home exercises are recommended. Additionally, the pain that accompanies recovery from a major procedure like this one can be managed with pain medications such as NSAIDs.
Potential complications from femoral osteotomy include: