[Operative Treatment for Saddle-Shaped Femoral Heads].

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Hip joint preservation

Background:

• Saddle-shaped deformity of the femoral head leads to poor prognosis and secondary changes.
• Existing treatments have limitations in preserving hip joint longevity.
• A new intra-articular anteromedial wedge reduction osteotomy (AWRO) technique is proposed.

Purpose of the Study:

• To evaluate the safety and effectiveness of the AWRO procedure.
• To confirm the hypothesis that AWRO improves functional and radiological parameters.
• To assess long-term outcomes in patients with severe hip deformities.

Main Methods:

• Retrospective study of 12 patients (2010-2013) with Stulberg grade V hips, hinged abduction, pain, limping, and limited range of motion.
• AWRO performed via anterolateral approach with subperiosteal vessel protection; central necrotic femoral head removed, medial segment mobilized and fixed.
• Pre- and post-operative assessment of Stulberg grade, capital diaphyseal index, caput-collum-diaphyseal angle, and Harris hip score; statistical analysis using paired t-test.

Main Results:

• Average follow-up of 55 months in 12 patients (8 boys, 4 girls; average age 14).
• Significant improvement in average Harris hip score (54.52 to 73.58).
• Improved Stulberg grades, decreased capital diaphyseal index (1.56 to 1.28), increased caput-collum-diaphyseal angle (134° to 140°); avascular necrosis in 2 patients.

Conclusions:

• AWRO is a viable salvage procedure for incongruent hips with high morbidity.
• The technique effectively prolongs joint longevity and significantly improves outcomes.
• Results confirm the hypothesis of improved functional and radiological parameters post-AWRO.