Indications and techniques of proximal femoral osteotomies in 2026

Proximal femoral osteotomy remains an important joint-preserving option for adolescents and young adults with symptomatic proximal femoral deformity, preserved cartilage, and deformity amenable to correction. Surgical hip dislocation provides circumferential access to the femoral head, neck, and acetabulum while preserving the retinacular blood supply, and it allows direct dynamic assessment of impingement together with concomitant treatment of intra-articular pathology. The extended retinacular flap has expanded the indications for intra-articular correction at the femoral neck and head level, enabling larger corrections closer to the deformity with less secondary displacement when compared to extra-articular osteotomies. Preoperative planning must combine standardized radiographs, CT- or MRI-based torsion analysis, and MRI-based cartilage assessment; outcomes depend mainly on cartilage status, patient age, timing of correction, and technical precision.