Osteotomies Around the Hip: A Comprehensive Overview
Osteotomies around the hip are surgical procedures involving the precise cutting and realignment of the proximal femur, acetabulum, or both to correct deformities, redistribute joint forces, and delay or prevent progression of hip pathology such as osteoarthritis. These operations aim to improve joint congruency, restore biomechanics, and prolong native joint function, thus potentially postponing or avoiding total hip arthroplasty (THA).
This answer will cover the relevant anatomy and biomechanics of the hip, common pathologies addressed, classification of different osteotomy types, clinical presentation, investigative work-up, detailed principles of management including indications and contraindications, surgical techniques, complications, rehabilitation, and outcomes.
Anatomy and Biomechanics of the Hip Relevant to Osteotomy
The hip is a ball-and-socket synovial joint composed of the femoral head articulating with the acetabulum of the pelvis. Stability depends on bony congruity and soft tissue constraints. Key anatomical considerations for osteotomies include:
- Proximal femur: Consists of the femoral head, neck, greater and lesser trochanters. The femoral neck-shaft angle typically ranges from 125°-135°, which determines load transmission.
- Acetabulum: Forms the socket, with an anterosuperior orientation and coverage influencing load distribution across the joint surface.
- Muscle attachments: Abductors- gluteus medius and minimus insert at the greater…