[Total hip prosthesis after high femoral osteotomy]

This study reviews a series of 75 total hip prosthesis (THP) after high femoral osteotomy operated on between 1968 and 1986. The mean delay between osteotomy and THP was 14 years. 53 prosthesis were available for long term follow-up with a mean follow up of 7 years. It was included in the category of total hip prosthesis operations considered as difficult. The lateral view is indispensable to plan the operation. Valgus intertrochanteric osteotomies and moderate internal translations posed no problems. Trochanteric osteotomy did not have to be systematic; it's inconveniences were not neglectible. It was reserved for isolated varizations for it modifies the axis of entry of the stem. The reamer was used in cases of narrowing of the femoral canal; notably after significant medializations. Derotation osteotomy was the last resort when it was impossible to position the stem secondary to a subtrochanteric osteotomy or significant angulation in the sagittal plane. An intertrochanteric osteotomy, when correctly realised, posed few problems during placement of a total hip prosthesis and licits a continued use in young subjects. Results of THP after intertrochanteric osteotomy compared well with primary THP, with 77.5 per cent good results and 15 per cent loosening. In addition to problems posed by etiologies (congenital dislocations), subtrochanteric osteotomies rendered cementing extremely difficult, even impossible. At long term, only 14.5 per cent of the results were good and the loosening rate was 45 per cent. Fortunately subtrochanteric osteotomies are practically abandoned.