Results of intra-articular and combined interventions in patients with ischemic deformity of the femoral head

Introduction Extra-articular operations for correction of ischemic deformities of the femoral head are not effective enough. Currently, intra-articular correction methods are used, among which one of the most effective methods is considered to be reduction osteotomy of the femoral head.

Purpose The aim of the work is to evaluate the results of intra-articular and combined interventions in patients with ischemic deformity of the femoral head.

Materials and methods The study included patients with ischemic deformity of the head and proximal femur (n = 15), divided into two groups. In the first group (n = 7), the patients underwent reduction osteotomy of the head using only the Ganz technique. Patients of the second group (n = 8) additionally underwent surgery on one or both joint components: corrective intertrochanteric osteotomy of the femur, pelvic osteotomy, or combined intervention. The joint was fixed with the Ilizarov apparatus.

Results The average D'Aubigne-Postel score in the first group was (14.7 ± 0.3) points, in the second group — (15.0 ± 0.2) points. When analyzing the radiometric data after treatment, a reliable improvement in the parameters characterizing the sphericity and the degree of head centralization was recoreded in patients of both groups. Radiographic results of patients in the first group: good result — 3 joints (43 %), fair — 3 joints (43 %), poor — 1 joint (14 %); the second group: good result — 3 joints (38 %), fair — 4 joints (50 %), poor result — 1 joint (12 %).

Discussion Simultaneously with the reduction osteotomy of the head, it is allowed to perform additional surgical interventions aimed at eliminating instability of the hip joint. Conducting a reducing osteotomy of the head in the conditions of a functioning growth plate is considered debatable.

Conclusion Intra-articular interventions that change the shape and improve the congruence of articular surfaces may be an alternative to early arthroplasty in adolescents and young adults in certain clinical situations.

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