Intertrochanteric femoral osteotomies for developmental and posttraumatic conditions.

Despite the numerous advances in technology and techniques for total hip arthroplasty, this surgery is often not the procedure of choice for all patients or for all hip conditions. Originally described as a treatment for femoral neck nonunions, the intertrochanteric femoral osteotomy retains an enduring role in the treatment of various posttraumatic and developmental hip conditions including femoral neck nonunions, iatrogenic or postsurgical deformities, leg-length inequality, osteonecrosis, slipped capital femoral epiphysis, deformities occurring after Legg-Calvé-Perthes desease, and for certain patients with dysplasia and secondary arthritis. By correcting deformity (either acquired or developmental), the intertrochanteric osteotomy can restore a more normal biomechanical geometry to the hip joint, which can increase the likelihood of improved longevity of the articulation. Excellent results have been reported by numerous authors using this procedure alone or in association with simultaneous or staged osteotomy of the pelvis. Factors that are common to most successful series are an emphasis on proper patient selection, detailed preoperative step-by-step planning, and meticulous intraoperative technique. Surgical intervention prior to the development of irreversible articular deterioration may result in dramatic short-term relief of pain because of improvements in biomechanics and relief of impingement. Long-term results include elimination of the need for total hip arthroplasty or postponement o f the need for this surgery for a meaningful number of years (such as 10 years or more).