Intertrochanteric Corrective Osteotomy as a Joint-Saving Surgical Treatment for Femoral Head Necrosis

Forty-seven intertrochanteric osteotomies were performed in 9 years on 40 patients with femoral head necrosis in Arlet and Ficat stages II and III in the Orthopaedic Department of the Medical School, Hannover. With an average follow up of 5.9 years (minimum 2.3 years, maximum 9.3 years), the study shows only 46% of the patients with satisfactory, good and very good results. After the joint saving operation, 26% of treated patients with pre-operative employment went into premature retirement. The average postoperative non-working period was 11 months (7-18 months). Clinical Relevance The results after the joint-saving operation were better when the operation was performed at an early stage of the disease with only a small area of necrosis. Although the operation will not prevent a progression of necrosis and a secondary arthrosis, we recommend that the joint-saving operation be performed during stages I and II to prolong the period before a total hip joint replacement becomes necessary. During stage III a total hip joint replacement may be preferable depending on clinical symptoms, patient age and the radiological findings (necrosis angle > 180°).