Abstract
Proximal femoral osteotomy was a common procedure prior to modern total hip replacement. It is seldom done now as the results were unpredictable, complications common and morbidity substantial. Eventually almost all required a total hip replacement.
In carrying out a total hip replacement after inter-trochanteric osteotomy there may be a problem with hardware removal which is sometimes best done as an interval procedure as the hardware may have been in place for decades and the appropriate screw driver not available, necessitating the use of a crown drill to remove the screws. After a varus inter trochanteric osteotomy the tip of the greater trochanter may overlie the medullary canal necessitating re-osteotomy. Most sub-trochanteric osteotomies will require re osteotomy.
A review has been carried out with the author’s personal cases. There were fourteen previous varus osteotomies two being non-unions. There was one non-union of a re-osteotomy and 17% continued to have a severe limp. Harris scores were acceptable in all. There were 20 valgus osteotomies. Limp was mild in 20% and severe in 3.5%. The Harris Hip Score was acceptable in 95%. There were eleven subtrochanteric osteotomies. There was one non-union of a re-osteotomy. Limp was mild in 27.3% and severe in 27.3%. The Harris Hip Scores were acceptable in all.
The results in terms of limp are disappointing. The de-functioned glutei may never recover in the same way a long standing rotator cuff muscles may undergo fatty degeneration. The patient should be warned of this possibility pre-operatively.
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