Indications for Acetabular and Femoral Osteotomies for the Non-Arthritic Hip

The goal of this review is to explore the role of acetabular and femoral osteotomies in the treatment of hip dysplasia and femoroacetabular impingement (FAI). We aim to answer key questions regarding the indications and outcomes associated with these procedures in managing both conditions. Hip dysplasia and FAI are often interrelated, with joint malalignment contributing to the development of pain, dysfunction, and early osteoarthritis. Acetabular and femoral osteotomies have been shown to restore proper alignment, alleviate symptoms, and delay the need for joint replacement.

Acetabular osteotomy is effective for improving patient symptomatology secondary to hip dysplasia by improving coverage and reducing instability. Further, it can delay or obviate the need for hip replacement. Femoral osteotomy, on the other hand, addresses excessive femoral anteversion in instability or retroversion in FAI. Both procedures are most effective when performed early in the disease process, prior to the onset of cartilage degeneration. Major takeaways include the importance of precise preoperative imaging, careful patient selection, and significant surgical expertise. Additionally, while both osteotomies can significantly improve function and delay arthritic progression, concomitant procedures like hip arthroscopy and osteochondral autograft and allograft transplantation are still being evaluated, underscoring the need for continued research in this area.