Greater trochanteric hip arthroplasty in children with loss of the femoral head.

In seventeen children with catastrophic loss of the femoral head, the hip was salvaged by greater trochanteric arthroplasty. The average follow-up of these patients was eleven years, and fourteen patients were followed to skeletal maturity or longer. In Group I, consisting of four patients with greater trochanteric arthroplasty alone, good initial stability gradually deteriorated as subluxation occurred, accompanied by a proportionate return of abductor limp, loss of hip motion, and an increased rate of degenerative changes in the joint. Group II, consisting of eight patients who had either acetabuloplasty or innominate osteotomy in addition to greater trochanteric arthroplasty, had only slightly improved hip containment and results similar to those in Group I. Spontaneous ankylosis of the hip occurred in six of the patients in those two groups. The best results were obtained in five patients in Groups III and IV who had the procedure supplemented by proximal femoral varus osteotomy.