Long-term result after femoral head substitution in postinfectious aplasia of the femoral head.

Abstract

This case report presents a new and unique surgical greater trochanter split procedure for reconstructing a hip joint after an infantile hip sepsis with consequent aplasia of the femoral head. One patient underwent the new trochanter split osteotomy for postinfectious aplasia of the femoral head at the age of 4 years. A follow-up of 17 years is presented. The remaining proximal femur is sagittally split and the medial part is shifted into the acetabulum, preserving the lateral part of the greater trochanter. The osteotomy is fixed by an osseous wedge and K-wires. In contrast to the techniques known so far, it does not harm the vastogluteal muscle sling, thus, significantly reducing abductor lurch. Furthermore, through placing juvenile growth cartilage from the greater trochanter area into the acetabulum, there is, by far, more potential for the regeneration of a femoral head than by the procedures known so far. The presented surgical technique is able to improve the biomechanics of a hip joint with postinfectious aplasia of the femoral head. The growth of a new femoral head and the development of a well-shaped acetabulum is enabled. A clinical outcome with a stable joint and very good clinical function can be achieved.