Hip Osteotomy

Depending on your hip condition, your doctor may recommend surgery to cut and reshape part of the bone, called an osteotomy. There are many types of pelvic osteotomy procedures. The three main groups are reshaping, redirectional, and salvage/augmentation.

What conditions are treated with hip osteotomy?

Several hip conditions may benefit from osteotomy. These include:

• Avascular necrosis
• Hip dysplasia
• Partial or full hip dislocation
• Legg-Calve-Perthes disease
• Hip instability

What are reshaping osteotomies?

During a reshaping osteotomy, your surgeon will change the volume and size of your hip socket (acetabulum). These include Pemberton, Pembersal, and San Diego approaches.

• Pemberton osteotomy
  This type of osteotomy is typically used in children younger than 6 to correct moderate to severe hip dysplasia that affects both sides. During the surgery, the surgeon cuts the hip socket and rotates it in a way that increases the overall depth of the socket.

What are redirection osteotomies?

A redirectional osteotomy changes the orientation of your hip socket. These include Sutherland, Dega, Salter, Steel, Tonnis, and Ganz osteotomies.

• Dega osteotomy
  A Dega osteotomy may be used if the hip socket is shallow and too wide. The surgeon cuts the hip bone and moves it downward to better cover the top of the thigh bone.
• Salter osteotomy
  A Salter osteotomy is typically performed in kids between 18 months and 6 years old. During surgery, the surgeon cuts the hip bone and then rotates it to cover the top of the thigh bone.
• Steel osteotomy
  This osteotomy procedure is similar to a Salter osteotomy. However, it involves two incisions and additional cuts to the hip bone before rotating it into place.
• Ganz osteotomy
  Ganz osteotomy is used in adolescents and young adults, in addition to children. It corrects the position of the hip when the growth plate has closed around the hip socket.

What are salvage/augmentation osteotomies?

If you have a salvage or augmentation osteotomy, your surgeon will work to improve the coverage of the top of your thigh bone (femoral head). These surgeries include the shelf procedure and the Chiari.

• Shelf procedure
  This surgery is used for those with residual hip dysplasia, which means the hip does not grow as it should after the original treatment of developmental hip dysplasia.
• Chiari osteotomy
  This surgery is typically used in severe cases of hip dysplasia, where other osteotomy approaches have not worked as they should. It may also treat partial dislocation of the hip and early osteoarthritis.

What are the risks of pelvic osteotomy?

Complications are rare, but they may include:

• Damage to the blood vessels or nerves
• Bone formation in places it does not normally grow
• Delayed bone graft union
• Damage within the joint

What is femoral osteotomy?

While pelvic osteotomy makes changes to the hip socket, femoral osteotomies reshape the top of the thigh bone. During a femoral osteotomy, the surgeon cuts the top of the thigh bone to better fit it into the socket. In some cases, the surgeon may shorten the thigh bone. To hold the correct position, the surgeon places metal rods, pins, or plates into the hip.