Is there still any place for femoral osteotomy in conservative hip surgery?

Background: Traditional proximal femoral osteotomy for the correction of architectural deformities has declined in frequency due to the technical complexity of lateral approaches, extensive soft tissue disruption, and prolonged postoperative recovery. While hip arthroplasty is often preferred, joint-preserving salvage surgery remains indicated for young adults with severe femoral malalignment to delay or prevent secondary osteoarthritis.

Objective: This article describes a minimally invasive surgical technique for proximal femoral osteotomy utilizing the Hueter anterior approach and evaluates its clinical outcomes and technical advantages.

Key Points: The procedure utilizes an intermuscular and interneural plane between the tensor fasciae latae and rectus femoris, preserving the gluteal musculature and the medial femoral circumflex artery. Technical variations include varus, valgus, and derotation osteotomies performed at the base of the femoral neck. Fixation is achieved using cannulated screws and, in valgus or derotation cases, hydroxyapatite or bone wedges to maintain correction. In a series of 15 hips with a mean follow-up of four years, the average Harris Hip Score improved from 60 to 90. Most patients achieved full weight-bearing within two months without instances of femoral head necrosis. The technique allows for simultaneous intra-articular procedures, such as labral repair or mosaicplasty, through a single incision.

Conclusion: The minimally invasive anterior approach for proximal femoral osteotomy facilitates accelerated rehabilitation and high union rates while preserving the femoral diaphysis for potential future arthroplasty. It represents a viable joint-preserving option for young patients with complex hip deformities.