Pelvic and femoral osteotomy in the treatment of hip disease in the young adult.

Osteotomies of the pelvis and upper femur play a useful and enduring role in the overall management of posttraumatic and developmental conditions of the hip. Rotational osteotomies of the pelvis have supplanted intertrochanteric osteotomies for treatment of most dysplasia-related conditions. In particular, the Bernese (Ganz) periacetabular osteotomy with lateral muscle sparing has emerged as the most effective and widely used pelvic osteotomy. Other methods, such as the Tönnis juxta-articular and triple innominate, also can be successful. These procedures have a risk profile that demands respect for the possible occurrence of significant complications and outcomes that are not uniformly excellent. Once significant arthritis is present, total hip arthroplasty is the procedure of choice in most instances. On the femoral side, the effectiveness of valgus osteotomy for femoral neck nonunion is unquestioned. Precollapse osteonecrosis is not a contraindication. Limb-length inequalities, malrotations, and displacements of posttraumatic deformities can be uniquely benefited by intertrochanteric osteotomy. Grade II slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, and osteonecrosis sometimes can be effectively treated with intertrochanteric osteotomy. All osteotomies should be planned and performed in a manner that anticipates the possible need for future conversion to total hip replacement.