Osteotomy means cutting of the bone and so femoral osteotomy means cutting of the femur bone.
Osteotomies can be used to correct a variety of problems but here we will focus on relieving arthritic pain and as an alternative to a hip replacement.
The purpose of the procedure is to re-align the load bearing surfaces of the joint. This can bring about significant pain reduction and may also promote the repair of cartilage.
With the very real advancements made in hip replacement surgery, especially for younger patients, the number of femoral osteotomies carried out has declined.
The procedure is normally carried out in two parts: -
Osteotomies can be used to correct a variety of problems but here we will focus only on relieving pain in arthritis and only as an alternative to a hip replacement.
During the first operation the bone is cut and repositioned and/or reshaped, A metal plate (see illustration) is inserted to pin the bone in place.
Healing will take a long time and some patients are very aware of the plate and find it uncomfortable.
The second operation removes the plate. This is a relatively straightforward procedure and less time is needed for recovery.
A minimum of 12 months is required between the two operations.
Advantages of Femoral Osteotomy
- The procedure may facilitate cartilage repair
- Femoral osteotomy may delay, or reduce, the need for hip replacement for anything up to 10 years
- It should relieve pain and increase mobility
- There are no artificial parts to wear out as there are with hip replacements
- It conserves bone mass so that a hip replacement may be carried out at a later date
- It is suitable for younger, more active patients
Disadvantages of Femoral Osteotomy
- The procedure is less suitable for older patients
- Recovery may be take a long time and will involve two operations
- There is a risk of avascular necrosis (where the blood supply to the bone is interrupted and which may result in the bone dying.
- There is a risk of nerve damage
- It is more suitable for patients with early arthritis with only between 1/3 and 1/2 of patients with advanced osteoarthritis being considered suitable
- There is a risk of developing compartment syndrome - where the nerves, blood vessels and muscles inside a closed space (compartment) become compressed and die due to lack of oxygen
- Some patients find the plate uncomfortable
It is possible to bring about a similar result by working on the acetabulum (the socket of the hip joint) but this is only appropriate for a small group of patients.
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Differnt types of hip problems.
Choosing the best time for hip replacment surgery
The debate around glucosamine or chondroitin
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