Osteoarthritis of the hip treated by intertrochanteric osteotomy. A long-term follow-up

We reviewed the early and late results of 103 consecutive intertrochanteric osteotomies of the hip. One year postoperatively, 70 per cent of the operations had had a good effect; 11 per cent, some effect; and 19 per cent, no effect. After five years 51 per cent of the hips still showed benefit from the operation and after ten years 30 per cent still showed benefit, whereas after five years 24 per cent had had a total hip replacement or an arthrodesis and after ten years 42 per cent had done so. Regression of the osteoarthritis was seen radiographically in 12 per cent of the hips. Hips that had had a broken Shenton line before the osteotomy had a significantly better five-year outcome compared with those that did not. Other preoperative factors, such as sex, age, pain, walking ability, range of hip motion, radiographic grade and localization of the osteoarthritis, presence of pseudocysts, femoral neck-shaft angle, and width of the central joint space, did not correlate with the five-year results. Osteotomies with medial displacement of twenty millimeters or more that were fixed with a Wainright implant showed significantly better results than those with less displacement. The investigation showed that the clinical effect of an intertrochanteric osteotomy is unpredictable and not as long-lasting as was previously believed. Thus, the operation should be carried out only in younger patients, as the pain relief and functional results compare unfavorably with those of total hip replacement.