Femoral Osteotomy Workup

  • Author: Austin T Fragomen, MD; Chief Editor: William L Jaffe, MD   more...
 
Updated: Feb 28, 2012
 

Laboratory Studies

In determining the appropriateness of a femoral osteotomy, the appropriate tests and imaging techniques should be performed.

  • Obtain a white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level if infection is suspected.
  • If osteonecrosis is present, then an investigation of the etiology may be indicated.
  • Routine preoperative blood work is indicated.
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Imaging Studies

  • Radiography
    • Standing anteroposterior pelvis radiographs to measure neck-shaft angle and assess the hip joint integrity
    • Cross-table lateral of the involved hip to assess sagittal deformity
    • Standing bipedal 51-inch radiograph including the top iliac crests to below ankle joints to assess deformity and leg length
  • Bone scanning
    • To assess for nonunion
    • To assess for infection
  • CT scanning (helpful in some instances): Hip CT scanning can help confirm the presence of a nonunion.
  • MRI: This can help assess for osteomyelitis and can evaluate the condition of the hip joint.
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Contributor Information and Disclosures
Author

Austin T Fragomen, MD  Assistant Professor of Orthopedic Surgery, Weill Medical College of Cornell University; Assistant Attending, Department of Orthopedic Surgery, and Fellowship Director, Limb Lengthening and Reconstruction Service, Hospital for Special Surgery

Austin T Fragomen, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America

Disclosure: Biomet Grant/research funds None; Smith and Nephew Grant/research funds Consulting; SBi Honoraria Consulting

Coauthor(s)

S Robert Rozbruch, MD  Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; Associate Attending, Department of Orthopedic Surgery, Hospital for Special Surgery; Assistant Attending, Department of Orthopedic Surgery, New York Presbyterian Hospital, Cornell Medical Center

S Robert Rozbruch, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Eastern Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, and Orthopaedic Trauma Association

Disclosure: small bone innovations Consulting fee Speaking and teaching

Specialty Editor Board

Steven I Rabin, MD  Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

B Sonny Bal, MD  Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD  Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine

Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

References

  1. Hadjicostas PT, Thielemann FW. The use of trochanteric slide osteotomy in the treatment of displaced acetabular fractures. Injury. Jul 1 2008;[Medline].

  2. Barr RJ, Santore RF. Osteotomies about the hip-Adults. Chapman's Orthopaedic Surgery 3rd ed. 2001;2723-28.

  3. Papagelopoulos PJ, Trousdale RT, Lewallen DG. Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop. 1996;322:151-62. [Medline].

  4. Bartonicek J, Skala-Rosenbaum J, Dousa P. Valgus intertrochanteric osteotomy for nonunion of trochanteric fractures. J Orthop Trauma. 2003;17:606-12. [Medline].

  5. Hammer AJ. Nonunion of subcapital femoral neck fractures. J Orthop Trauma. 1992;6:73-7. [Medline].

  6. Roshan A, Ram S. The neglected femoral neck fracture in young adults: review of a challenging problem. Clin Med Res. May 2008;6(1):33-9. [Medline].

  7. Yang L, Jing Y, Hong D, Chong-Qi T. Valgus osteotomy combined with intramedullary nail for Shepherd's crook deformity in fibrous dysplasia: 14 femurs with a minimum of 4 years follow-up. Arch Orthop Trauma Surg. Apr 2010;130(4):497-502. [Medline].

  8. Firth GB, Robertson AJ, Schepers A, Fatti L. Developmental Dysplasia of the Hip: Open Reduction as a Risk Factor for Substantial Osteonecrosis. Clin Orthop Relat Res. Jun 8 2010;[Medline].

  9. Eastwood DM, de Gheldere A. Clinical examination for developmental dysplasia of the hip in neonates: how to stay out of trouble. BMJ. May 12 2010;340:c1965. [Medline].

  10. Varner KE, Incavo SJ, Haynes RJ, Dickson JH. Surgical Treatment of Developmental Hip Dislocation in Children Aged 1 to 3 Years: A Mean 18-Year, 9-Month Follow-Up Study. Orthopedics. Mar 10 2010;162-166. [Medline].

  11. Barker KL, Lamb SE, Simpson HR. Recovery of muscle strength and power after limb-lengthening surgery. Arch Phys Med Rehabil. Mar 2010;91(3):384-8. [Medline].

  12. Paley D. Principles of Deformity Correction. New York, NY: Springer-Verlag Berlin Heidelberg. 2002;1-18.

  13. Kim HK, da Cunha AM, Browne R, Kim HT, Herring JA. How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in legg-calve-perthes disease?. J Bone Joint Surg Am. Feb 2011;93(4):341-7. [Medline].

  14. Haverkamp D, Marti RK. Intertrochanteric osteotomy combined with acetabular shelfplasty in young patients with severe deformity of the femoral head and secondary osteoarthritis. A long-term follow-up study. J Bone Joint Surg Br. 2005;87:25-31. [Medline].

  15. Paliobeis CP, Kanellopoulos AD, Babis GC, Magnissalis EA, Catling JC, Papagelopoulos PJ, et al. Intrinsic passive stiffness of 2 constructs of varus proximal femoral osteotomy: external fixator or blade plate. J Pediatr Orthop. Jun 2010;30(4):351-6. [Medline].

  16. McGrory BJ, Estok DM 2nd, Harris WH. Follow-up of intertrochanteric osteotomy of the hip during a 25-year period. Orthopedics. 1998;21:651-3. [Medline].

  17. Yoo JJ, Kim YM, Yoon KS, et al. Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study. J Bone Joint Surg Am. 2005;87:530-5. [Medline].

  18. Mehra A, Hemmady MV, Hodgkinson JP. Trochanteric non-union--does it influence the rate of revision following primary total hip replacement? A minimum of 15 years follow-up. Surgeon. Apr 2008;6(2):79-82. [Medline].

  19. Seki T, Hasegawa Y, Masui T, Yamaguchi J, Kanoh T, Ishiguro N, et al. Quality of life following femoral osteotomy and total hip arthroplasty for nontraumatic osteonecrosis of the femoral head. J Orthop Sci. Mar 2008;13(2):116-21. [Medline].

 
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This severe vertical fracture line through the femoral neck is a high risk for nonunion with simple pinning fixation.
The fracture is stabilized with a screw, and then a 95° blade is inserted. Proximal femoral osteotomy is created and a wedge removed.
Final image showing a valgus-producing osteotomy with improved orientation of the femoral neck fracture.
Painful nonunion of a peritrochanteric fracture in varus position with shortening and broken hardware.
Repair of nonunion with a 95° blade plate with restoration of normal alignment and equalization of limb length.
Osteonecrosis localized to a small area of the weightbearing portion of the femoral head.
Proximal femoral osteotomy was performed and the head was positioned into more valgus. In so doing, the affected portion of the femoral head is rotated away from the weightbearing area. External fixation was selected in this example.
Follow-up radiographs demonstrate a well-healed osteotomy with maintenance of the valgus positioning.
 
 
 
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