Intertrochanteric osteotomy for the treatment of coxarthrosis

Abstract

Intertrochanteric osteotomy of the femur as a joint-preserving procedure for the treatment of coxarthrosis depends, according to Pauwels, on the idea of calculated lowering of mechanical stress and changing of the quality of joint strain. In order to meet this rationale it is necessary to provide for optimal joint congruity. This traditionally means the creation of a joint space that is as "symmetrical" as possible, which can be demonstrated by means of conventional radiograms. In fact, however, the largest possible areas of hyaline cartilage of the best possible quality need to be positioned so that they articulate upon each other. Unfortunately, as yet no adequate methods are available of picturing the actual and the intended congruity: at least the traditional imaging techniques applied in living persons do not fulfil this. Since therefore exact preoperative planning is presently impossible, the results, unfortunately, are to some extent a matter of chance. Nevertheless, clinical long-term follow-up examination revealed that about 50% of patients continue satisfied even after 10 years, since they have no pain at all or at most minimal pain. Thus, intertrochanteric osteotomy still offers good relief in properly selected cases and there is often no need for early alloarthroplasty.