Proximal Femoral Osteotomy for Treatment of Femoral Head Osteoarthritis

During the past 20 years, poximal femoral osteotomy has been forgotten because most orthopedic surgeon believed that total hip arthroplasty is the only treatment method for hip joint osteoarthritis.
The disadvatages of proximal femoral osteotomy include: Uncertain results, prolonged rehabilitation time after surgery, little improvement in joint ROM and according tosome.euthors difficult subsequent total hip arthropl88ly.
However, longterm complications of total hip arthroplasty with cement in young adults and some senile patients should be taken into proximal femoral osteotomy again, because this procedure reduce pain in both groups of patients.
The application of osteotomy is when the patient is well cooperative and the hip joint has acceptable range of motion.
If under general anesthesia the passive range of motion of hip is less than 15' adduction and 3D-50' flexion, because the risk of joint ankylosis, osteotomy is not indicated. In this situation the total hip arthroplasty is the treatment of choice. Rarly osteotomy increase hip range of motion and thus osteotomy is contraindicated in patients with limited ranye of motion of hip joint.
The main goals of osteotomy include:1- Reduction of pain
2- Reduction of forces of joint
3- Preserve of horizontal weight bearing surface
These goals is achived by a proximal femoral osteotomy, but if weight bearing suttece. takes aposition other than horizontal, another complementary pelvic or acetabular osteotomy is also required.
In severe superolateral acetabular osteoarthritis, a valgus extension osteotomy is required to change the hip mechanics and repair of anterosuperolateral slope.
In medial hip osteoarthritis a valgus osteotomy is indicated when femoral head is still spherical but varus osteotomy is not indicated in medial hip osteoarthritis because increases the horizontal vectors of forces and is ... .