Proximal femoral reconstruction for hip involvement in hereditary multiple exostoses

Hip involvement in hereditary multiple exostoses (HME) may lead to coxa valga, femoral impingement and progressive hip subluxation. This study aimed to evaluate the outcomes of a single-stage technique combining proximal femoral varus osteotomy with femoral neck osteochondroma trimming performed through the osteotomy site.

A retrospective series of fifteen patients (23 hips) with HME was reviewed. Clinical outcomes were assessed using the Postel-Merle d'Aubigné score. Radiographic evaluation included femoral and acetabular parameters assessed pre-operatively, immediately post-operatively and at latest follow-up.

Mean age at surgery was 10.1 years, with a mean follow-up of nine years. Surgery achieved immediate correction of the neck-shaft angle and improved femoral head containment. At latest follow-up, significant improvement was observed in both femoral and acetabular parameters, suggesting secondary acetabular remodelling. Clinical scores improved significantly, with resolution of pain. Four nonunions required revision surgery, highlighting the technical demands of fixation in compromised bone. Loss of correction tended to occur more frequently in younger patients, with age below nine years associated with a higher risk of secondary valgus recurrence. No cases of femoral head avascular necrosis were observed.

This combined femoral approach allows effective correction of proximal femoral deformity while facilitating osteochondroma resection, providing durable containment and favourable mid-term outcomes.